=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508467416
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DEBORAH BERENICE ENIX WILLIAMS OTR/L
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/06/2020
-----------------------------------------------------
Last Update Date | 11/06/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 26261 KING EDWARDS DR
-----------------------------------------------------
City | LOMA LINDA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92354-4158
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-645-6840
-----------------------------------------------------
Fax | 909-799-8214
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1478
-----------------------------------------------------
City | LOMA LINDA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92354-1478
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-645-6840
-----------------------------------------------------
Fax | 909-799-8214
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225XE1200X
-----------------------------------------------------
Taxonomy Name | Ergonomics Occupational Therapist
-----------------------------------------------------
License Number | OT5382
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225XP0019X
-----------------------------------------------------
Taxonomy Name | Physical Rehabilitation Occupational Therapist
-----------------------------------------------------
License Number | OT5382
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------