Provider Demographics
NPI:1275724429
Name:WILLIAMS, JENNIFER R (OTR)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:R
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2509 COUNTY HIGHWAY I
Mailing Address - Street 2:
Mailing Address - City:CHIPPEWA FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54729-2785
Mailing Address - Country:US
Mailing Address - Phone:715-717-4944
Mailing Address - Fax:
Practice Address - Street 1:2509 COUNTY HIGHWAY I
Practice Address - Street 2:
Practice Address - City:CHIPPEWA FALLS
Practice Address - State:WI
Practice Address - Zip Code:54729-2785
Practice Address - Country:US
Practice Address - Phone:715-726-3447
Practice Address - Fax:715-726-3649
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2829-26225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40799800Medicaid