Healthcare Provider Details

I. General information

NPI: 1821549494
Provider Name (Legal Business Name): JENNIFER WILLIAMS OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2016
Last Update Date: 10/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

536 OLD HOWELL RD
GREENVILLE SC
29615-1969
US

IV. Provider business mailing address

536 OLD HOWELL RD
GREENVILLE SC
29615-1969
US

V. Phone/Fax

Practice location:
  • Phone: 877-508-3237
  • Fax: 877-508-8714
Mailing address:
  • Phone: 877-508-3237
  • Fax: 877-508-8714

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT001650
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: