Healthcare Provider Details

I. General information

NPI: 1992217640
Provider Name (Legal Business Name): BRIANNA WILLIAMS OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2017
Last Update Date: 11/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17015 LAZY HILL LN
SPRING TX
77379
US

IV. Provider business mailing address

17015 LAZY HILL LN
SPRING TX
77379-4510
US

V. Phone/Fax

Practice location:
  • Phone: 432-940-8306
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number117918
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: