Healthcare Provider Details

I. General information

NPI: 1114320884
Provider Name (Legal Business Name): STEPHANIE WILLIAMS OTR/L, CHT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2014
Last Update Date: 10/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

574 E MAIN ST
INDEPENDENCE VA
24348-3879
US

IV. Provider business mailing address

574 E MAIN ST
INDEPENDENCE VA
24348-3879
US

V. Phone/Fax

Practice location:
  • Phone: 276-773-8118
  • Fax:
Mailing address:
  • Phone: 276-773-8118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number0119002503
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: