Basic Information
| Provider Information | |||||||||
| NPI: | 1548338296 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WILLIAMS | ||||||||
| FirstName: | AMY | ||||||||
| MiddleName: | C | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | OCCUPATIONAL THERAPI | ||||||||
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| Mailing Information | |||||||||
| Address1: | 118 HERRON STREET | ||||||||
| Address2: | |||||||||
| City: | FT OGLETHORPE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30742 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7068617471 | ||||||||
| FaxNumber: | 7068617472 | ||||||||
| Practice Location | |||||||||
| Address1: | 118 HERRON STREET | ||||||||
| Address2: | |||||||||
| City: | FT OGLETHORPE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30742 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7068617471 | ||||||||
| FaxNumber: | 7068617472 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/01/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | OT000201 | GA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
ID Information
| ID | Type | State | Issuer | Description | 3162266 | 01 | TN | BCBS | OTHER | 00667752A | 05 | GA | MEDICAID | 10052550 | 01 | AMERIGROUP | OTHER | 339905 | 01 | WELLCARE | OTHER | 52765883001 | 01 | GA | BCBS | OTHER |