Healthcare Provider Details

I. General information

NPI: 1164545646
Provider Name (Legal Business Name): NAOMI EVE WILLIAMSON PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 CIVIC AVE
SALISBURY MD
21804-4599
US

IV. Provider business mailing address

10050 BIRCH ST
LAUREL DE
19956-3758
US

V. Phone/Fax

Practice location:
  • Phone: 410-749-1466
  • Fax:
Mailing address:
  • Phone: 302-875-3154
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberA2946
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: