=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275718017
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JULIE WILLIAMS OTRL
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/28/2007
-----------------------------------------------------
Last Update Date | 01/31/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 500 TIGER BLVD SPECIAL SERVICES CENTER
-----------------------------------------------------
City | BENTONVILLE
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72712-4208
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 479-970-1227
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1395 N HERITAGE AVE
-----------------------------------------------------
City | FAYETTEVILLE
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72704-5575
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 479-970-1227
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225XP0200X
-----------------------------------------------------
Taxonomy Name | Pediatric Occupational Therapist
-----------------------------------------------------
License Number | OTR2145
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------