Provider Demographics
NPI:1023381522
Name:WILLIAMS, TODD CRAE (OTR/L)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:CRAE
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 E 1400 N
Mailing Address - Street 2:SUITE W
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84341-2406
Mailing Address - Country:US
Mailing Address - Phone:435-716-6440
Mailing Address - Fax:435-716-6441
Practice Address - Street 1:550 E 1400 N
Practice Address - Street 2:SUITE W
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84341-2406
Practice Address - Country:US
Practice Address - Phone:435-716-6440
Practice Address - Fax:435-716-6441
Is Sole Proprietor?:No
Enumeration Date:2012-02-14
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8152257-4201225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics