Provider Demographics
NPI:1477731941
Name:WILLIAMS, KRYSTAL DAWN (COTA)
Entity Type:Individual
Prefix:MRS
First Name:KRYSTAL
Middle Name:DAWN
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-2808
Mailing Address - Country:US
Mailing Address - Phone:817-336-2586
Mailing Address - Fax:
Practice Address - Street 1:1000 6TH AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2808
Practice Address - Country:US
Practice Address - Phone:817-336-2586
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-06
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX209294224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant