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General NPI Number Information
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NPI Number | 1053033597
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Entity Type | Individual
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Provider Name | TIERNEY DESIREE WILLIAMS OTR/L
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Gender | Female
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Dates
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Enumeration Date | 09/12/2022
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Last Update Date | 09/12/2022
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Provider Practice Location Address
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Address Line | 3006 MCNIEL AVE
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City | WICHITA FALLS
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State | TX
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Zip | 76309-4954
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Country | US
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Telephone | 940-691-7511
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Fax |
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Provider Business Mailing Address
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Address Line | 404 SWENSON ST
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City | BURKBURNETT
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State | TX
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Zip | 76354-2236
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Country | US
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Telephone | 901-859-9147
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 120934
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License Number State | TX
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