Provider Demographics
NPI:1346451911
Name:WILLIAMS, LINDA B (OTL)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:B
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:OTL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11954 S ASH ST
Mailing Address - Street 2:
Mailing Address - City:JENKS
Mailing Address - State:OK
Mailing Address - Zip Code:74037-3633
Mailing Address - Country:US
Mailing Address - Phone:918-296-5442
Mailing Address - Fax:
Practice Address - Street 1:10512 N 110TH EAST AVE
Practice Address - Street 2:SUITE 150
Practice Address - City:OWASSO
Practice Address - State:OK
Practice Address - Zip Code:74055-6636
Practice Address - Country:US
Practice Address - Phone:918-609-1300
Practice Address - Fax:918-609-1318
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKOT786225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1346451911Medicare PIN