MEDICARE: TAVIA WILLIAMS OTD, OTR/L

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	529745	TX

General Provider Information

NPI Number	:	1063305837
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAVIA WILLIAMS OTD, OTR/L

Provider Business Mailing Address
First Line	:	4534 WANDERING VINE TRL
Second Line	:
City	:	ROUND ROCK
State	:	TX
Zip	:	78665-1267
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4534 WANDERING VINE TRL
Second Line	:
City	:	ROUND ROCK
State	:	TX
Zip	:	78665-1267
Country	:	US
Telephone Number	:	870-390-6539
Fax Number	:

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

Provider Enumeration Date	:	05/31/2025
Last Update Date	:	05/31/2025

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