Provider Demographics
NPI:1194861864
Name:WILLIAMS, DENISE E (OTRL)
Entity Type:Individual
Prefix:MS
First Name:DENISE
Middle Name:E
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4800 S CHICAGO BEACH DR
Mailing Address - Street 2:SUITE 913N
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60615-7032
Mailing Address - Country:US
Mailing Address - Phone:773-624-4111
Mailing Address - Fax:773-624-4111
Practice Address - Street 1:4800 S CHICAGO BEACH DR
Practice Address - Street 2:SUITE 913N
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60615-7032
Practice Address - Country:US
Practice Address - Phone:773-624-4111
Practice Address - Fax:773-624-4111
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist