Healthcare Provider Details

I. General information

NPI: 1235963216
Provider Name (Legal Business Name): BRENNAN WILLIAMS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2024
Last Update Date: 09/04/2024
Certification Date: 09/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1991 FORDHAM DR
FAYETTEVILLE NC
28304-3773
US

IV. Provider business mailing address

1991 FORDHAM DR STE 102
FAYETTEVILLE NC
28304-3774
US

V. Phone/Fax

Practice location:
  • Phone: 910-484-3114
  • Fax:
Mailing address:
  • Phone: 910-484-4653
  • Fax: 910-483-9256

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number17075
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: