Provider Demographics
NPI:1447806864
Name:WILLIAMS, NICOLE BRIANA (OTD, OTR/L)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:BRIANA
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20425 N 7TH ST APT 3038
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85024-6018
Mailing Address - Country:US
Mailing Address - Phone:480-452-8131
Mailing Address - Fax:
Practice Address - Street 1:2150 S COUNTRY CLUB DR STE 20
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-6879
Practice Address - Country:US
Practice Address - Phone:480-398-4280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-12
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOTH-007838225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist