MEDICARE: CARSON WILLIAMS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	14767	NC

General Provider Information

NPI Number	:	1043966237
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARSON WILLIAMS

Provider Business Mailing Address
First Line	:	4350 FURMAN HALL APT 201
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27612-4175
Country	:	US
Telephone Number	:	910-375-0896
Fax Number	:

Provider Business Practice Location Address
First Line	:	4350 FURMAN HALL APT 201
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27612-4175
Country	:	US
Telephone Number	:	910-375-0896
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/25/2022
Last Update Date	:	04/18/2023

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