MEDICARE: OLIVIA CYMONE 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	343900000X	Non-emergency Medical Transport (VAN)

General Provider Information

NPI Number	:	1730840414
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLIVIA CYMONE WILLIAMS

Provider Business Mailing Address
First Line	:	990 CYPRESS STATION DR APT 1407
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77090-1549
Country	:	US
Telephone Number	:	346-405-2725
Fax Number	:

Provider Business Practice Location Address
First Line	:	6407 LAURA KOPPE RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77016
Country	:	US
Telephone Number	:	832-670-1774
Fax Number	:

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

Provider Enumeration Date	:	01/05/2022
Last Update Date	:	01/05/2022

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