Provider Demographics
NPI:1417071424
Name:WILLIAMS, VICTORIA LYNN (MHS, OTR)
Entity Type:Individual
Prefix:MRS
First Name:VICTORIA
Middle Name:LYNN
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MHS, OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1411 E COUNTY ROAD 900 N
Mailing Address - Street 2:
Mailing Address - City:PITTSBORO
Mailing Address - State:IN
Mailing Address - Zip Code:46167-9292
Mailing Address - Country:US
Mailing Address - Phone:317-374-5168
Mailing Address - Fax:
Practice Address - Street 1:1411 E COUNTY ROAD 900 N
Practice Address - Street 2:
Practice Address - City:PITTSBORO
Practice Address - State:IN
Practice Address - Zip Code:46167-9292
Practice Address - Country:US
Practice Address - Phone:317-374-5168
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2012-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31003270A225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200648620OtherFIRST STEPS
IN200300040Medicaid