MEDICARE: MRS. NATALIE JACKSON WILLIAMS 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	OT14226	FL

General Provider Information

NPI Number	:	1962803379
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NATALIE JACKSON WILLIAMS OTR/L

Provider Business Mailing Address
First Line	:	3612 CARROLLWOOD PLACE CIR
Second Line	:	APARTMENT 202
City	:	TAMPA
State	:	FL
Zip	:	33624-3068
Country	:	US
Telephone Number	:	813-240-1942
Fax Number	:

Provider Business Practice Location Address
First Line	:	3612 CARROLLWOOD PLACE CIR
Second Line	:	APARTMENT 202
City	:	TAMPA
State	:	FL
Zip	:	33624-3068
Country	:	US
Telephone Number	:	813-240-1942
Fax Number	:

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

Provider Enumeration Date	:	09/05/2014
Last Update Date	:	09/05/2014

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