Provider Demographics
NPI:1396828166
Name:WILLIAMSON, HEATHER CLANCY (OTR, CHT)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:CLANCY
Last Name:WILLIAMSON
Suffix:
Gender:F
Credentials:OTR, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:595 WATERVIEW TRAIL
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022
Mailing Address - Country:US
Mailing Address - Phone:770-513-8363
Mailing Address - Fax:770-513-8741
Practice Address - Street 1:1960 RIVERSIDE PARKWAY
Practice Address - Street 2:SUITE 104
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30043
Practice Address - Country:US
Practice Address - Phone:770-513-8363
Practice Address - Fax:770-513-8741
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2018-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA97110002252251H1200X
GA1111225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No2251H1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistHand