Provider Demographics
NPI:1184029928
Name:WILLIAMS, ANNMARIE (MSOTRL)
Entity Type:Individual
Prefix:MISS
First Name:ANNMARIE
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MSOTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4934 MATAPEAKES BOUNTY DRIVE
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20720
Mailing Address - Country:US
Mailing Address - Phone:718-913-0878
Mailing Address - Fax:
Practice Address - Street 1:12325 NEW HAMPSHIRE AVE
Practice Address - Street 2:SPRINGBROOK REHAB CENTER
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904
Practice Address - Country:US
Practice Address - Phone:301-622-4600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-22
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD06233172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker