Healthcare Provider Details

I. General information

NPI: 1043379910
Provider Name (Legal Business Name): CAROLINE KAY WILLIAMSON OTR L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2705 ENLOE ST
HUDSON WI
54016-8173
US

IV. Provider business mailing address

1425 RIVER RIDGE RD
RIVER FALLS WI
54022-3459
US

V. Phone/Fax

Practice location:
  • Phone: 715-386-2128
  • Fax:
Mailing address:
  • Phone: 715-426-5212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number4305
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: