Healthcare Provider Details

I. General information

NPI: 1437873924
Provider Name (Legal Business Name): HEATHER NICOLE WILLIAMSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2022
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

839 WILLOWMERE WAY
SPARTANBURG SC
29303-6660
US

IV. Provider business mailing address

6641 WESTVIEW DR
BRECKSVILLE OH
44141-2901
US

V. Phone/Fax

Practice location:
  • Phone: 440-409-2097
  • Fax:
Mailing address:
  • Phone: 440-409-2097
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number1585
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: