Provider Demographics
NPI:1477871051
Name:WILLIAMS, MICHAEL HENRY (COTA/L)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:HENRY
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6611 4TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34208-6084
Mailing Address - Country:US
Mailing Address - Phone:352-617-9068
Mailing Address - Fax:
Practice Address - Street 1:6611 4TH AVE NE
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34208-6084
Practice Address - Country:US
Practice Address - Phone:352-617-9068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-06
Last Update Date:2010-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA10333224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant