Basic Information
| Provider Information | |||||||||
| NPI: | 1689342610 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WILLIAMS | ||||||||
| FirstName: | BREANNA | ||||||||
| MiddleName: | MAY | ||||||||
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| Credential: | OTR/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7230 JACKSON CREEK PARKWAY | ||||||||
| Address2: | SUITE 220 | ||||||||
| City: | MONUMENT | ||||||||
| State: | CO | ||||||||
| PostalCode: | 80132 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7195970822 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7230 JACKSON CREEK PARKWAY | ||||||||
| Address2: | SUITE 220 | ||||||||
| City: | MONUMENT | ||||||||
| State: | CO | ||||||||
| PostalCode: | 80132 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7195970822 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/03/2021 | ||||||||
| LastUpdateDate: | 09/03/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/18/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | OT.0006885 | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.