Provider Demographics
NPI:1164721049
Name:WILLIAMS, THERESE M (OT/L, CHT)
Entity Type:Individual
Prefix:
First Name:THERESE
Middle Name:M
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:OT/L, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42615 GARFIELD RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-1653
Mailing Address - Country:US
Mailing Address - Phone:586-412-2845
Mailing Address - Fax:586-416-1497
Practice Address - Street 1:7164 N MAIN ST
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346-1569
Practice Address - Country:US
Practice Address - Phone:248-625-6400
Practice Address - Fax:248-625-6006
Is Sole Proprietor?:No
Enumeration Date:2011-03-18
Last Update Date:2011-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201003200225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand