Healthcare Provider Details

I. General information

NPI: 1992232763
Provider Name (Legal Business Name): SHIRLEY WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2017
Last Update Date: 05/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

809 SW 89TH ST SUITE C
OKLAHOMA CITY OK
73139-9360
US

IV. Provider business mailing address

809 SW 89TH ST SUITE C
OKLAHOMA CITY OK
73139-9360
US

V. Phone/Fax

Practice location:
  • Phone: 405-634-1497
  • Fax: 405-634-1919
Mailing address:
  • Phone: 405-634-1497
  • Fax: 405-634-1919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: