Healthcare Provider Details

I. General information

NPI: 1699048041
Provider Name (Legal Business Name): THERESA NABINETT WILLIAMS OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2012
Last Update Date: 11/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 HARRELSON RD
CHERRYVILLE NC
28021-9541
US

IV. Provider business mailing address

137 ANNE NEELY RD
GASTONIA NC
28056-9327
US

V. Phone/Fax

Practice location:
  • Phone: 704-435-0108
  • Fax:
Mailing address:
  • Phone: 704-813-9359
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number7772
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number4209
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: