Healthcare Provider Details

I. General information

NPI: 1154143733
Provider Name (Legal Business Name): ORLANDO MONTAGUE WILLIAMS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2024
Last Update Date: 10/25/2024
Certification Date: 10/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 GEORGE BINGHAM DR
LIMA OH
45807-3123
US

IV. Provider business mailing address

1515 GEORGE BINGHAM DR
LIMA OH
45807-3123
US

V. Phone/Fax

Practice location:
  • Phone: 419-516-1507
  • Fax:
Mailing address:
  • Phone: 419-516-1507
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: