=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265021828
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARY HERBERT WILLIAMSON OTR/L
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/18/2021
-----------------------------------------------------
Last Update Date | 01/18/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 206 TWINRIDGE LN
-----------------------------------------------------
City | NORTH CHESTERFIELD
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23235-5200
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-323-9060
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 206 TWINRIDGE LN
-----------------------------------------------------
City | NORTH CHESTERFIELD
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23235-5200
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-323-9060
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | 0119006184
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------