MEDICARE: MS. OLIVIA WILLIAMSON RBT

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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1417511247
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. OLIVIA WILLIAMSON RBT

Provider Business Mailing Address
First Line	:	606 STEAMBOAT SPRINGS AVE # 2418
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28403-5429
Country	:	US
Telephone Number	:	919-692-5385
Fax Number	:

Provider Business Practice Location Address
First Line	:	3317 MASONBORO LOOP RD UNIT 150
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28409-2970
Country	:	US
Telephone Number	:	910-599-2230
Fax Number	:

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

Provider Enumeration Date	:	04/26/2019
Last Update Date	:	04/26/2019

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