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General NPI Number Information
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NPI Number | 1902117096
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Entity Type | Individual
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Provider Name | JUSTIN BANKS WILLIAMS OTD, MS, OTR/L, PM
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Gender | Male
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Dates
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Enumeration Date | 06/23/2010
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Last Update Date | 09/19/2014
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Provider Practice Location Address
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Address Line | 10 FOUNTAINVIEW TER
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City | GREENVILLE
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State | SC
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Zip | 29607-4033
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Country | US
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Telephone | 864-233-6367
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Fax |
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Provider Business Mailing Address
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Address Line | 30 SPRINGCREST CT GENESIS REHAB SERVICES
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City | GREENVILLE
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State | SC
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Zip | 29607-4034
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Country | US
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Telephone | 864-528-5546
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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 | 225XG0600X
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Taxonomy Name | Gerontology Occupational Therapist
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License Number | 3679
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License Number State | SC
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