Healthcare Provider Details

I. General information

NPI: 1073329843
Provider Name (Legal Business Name): JENNY WILLIAMS OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2024
Last Update Date: 12/20/2024
Certification Date: 12/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 N MOUNT JULIET RD
MT JULIET TN
37122-3305
US

IV. Provider business mailing address

135 HORN DR
LEBANON TN
37087-1902
US

V. Phone/Fax

Practice location:
  • Phone: 615-429-6424
  • Fax:
Mailing address:
  • Phone: 615-336-0550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number2099
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: