Provider Demographics
NPI:1417040601
Name:WILLIAMS, JENNIFER (OT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:WOERNER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OT
Mailing Address - Street 1:2200 HARVARD RD
Mailing Address - Street 2:STE 101
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66049-2611
Mailing Address - Country:US
Mailing Address - Phone:785-842-0656
Mailing Address - Fax:
Practice Address - Street 1:2200 HARVARD RD
Practice Address - Street 2:STE 101
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66049-2611
Practice Address - Country:US
Practice Address - Phone:785-842-0656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS17-01929225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100458740AMedicaid