Healthcare Provider Details

I. General information

NPI: 1215748108
Provider Name (Legal Business Name): CHRISLOM WILLIAMS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2025
Last Update Date: 01/18/2025
Certification Date: 01/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4850 W FLAMINGO RD STE 25
LAS VEGAS NV
89103-3707
US

IV. Provider business mailing address

4495 N CAMPBELL RD
LAS VEGAS NV
89129-3624
US

V. Phone/Fax

Practice location:
  • Phone: 702-871-9917
  • Fax:
Mailing address:
  • Phone: 702-218-9503
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number0402
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: