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General NPI Number Information
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NPI Number | 1609947100
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Entity Type | Individual
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Provider Name | JACLYN ANN WILLIAMS PTA
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Gender | Female
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Dates
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Enumeration Date | 11/13/2006
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Last Update Date | 12/12/2023
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Provider Practice Location Address
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Address Line | 18109 PRINCE PHILIP DR SUITE 155
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City | OLNEY
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State | MD
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Zip | 20832-1519
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Country | US
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Telephone | 301-570-3138
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Fax | 301-570-3139
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Provider Business Mailing Address
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Address Line | 18109 PRINCE PHILIP DR
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City | OLNEY
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State | MD
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Zip | 20832-1519
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Country | US
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Telephone | 301-260-3280
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Fax | 301-260-3279
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | A3011
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License Number State | MD
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