Provider Demographics
NPI:1093358129
Name:WILLIAMS, AMANDA
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:227 LONGWOOD LN
Mailing Address - Street 2:
Mailing Address - City:BLUEMONT
Mailing Address - State:VA
Mailing Address - Zip Code:20135-4832
Mailing Address - Country:US
Mailing Address - Phone:540-514-5396
Mailing Address - Fax:
Practice Address - Street 1:21495 RIDGETOP CIR
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20166-8520
Practice Address - Country:US
Practice Address - Phone:540-514-5396
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-22
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics