Provider Demographics
NPI:1417254665
Name:WILLIAMS, MAEGAN ALYSSA (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:MAEGAN
Middle Name:ALYSSA
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MISS
Other - First Name:MAEGAN
Other - Middle Name:ALYSSA
Other - Last Name:PACHOMSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:304 E 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30161-6000
Mailing Address - Country:US
Mailing Address - Phone:706-378-9044
Mailing Address - Fax:706-378-9046
Practice Address - Street 1:304 E 6TH AVE
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30161-6000
Practice Address - Country:US
Practice Address - Phone:706-378-9044
Practice Address - Fax:706-378-9046
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-24
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251C00000X
GAOT006291225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No251C00000XAgenciesDay Training, Developmentally Disabled Services