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General NPI Number Information
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NPI Number | 1912526443
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Entity Type | Individual
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Provider Name | LAUREN WILLIAMSON
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Gender | Female
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Dates
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Enumeration Date | 04/14/2020
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Last Update Date | 04/14/2020
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Provider Practice Location Address
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Address Line | 5535 S WILLIAMSON BLVD STE 774
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City | PORT ORANGE
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State | FL
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Zip | 32128-8321
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Country | US
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Telephone | 888-265-2680
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Fax |
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Provider Business Mailing Address
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Address Line | 1805 RIDGEWOOD DR
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City | COLUMBIA
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State | MS
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Zip | 39429-2641
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Country | US
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Telephone |
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 19317
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT3528
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License Number State | MS
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