Provider Demographics
NPI:1497205033
Name:WILLIAMS, NICHOLAS R (MOT)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:R
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:MOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:652 S MEDICAL CENTER DR STE LL10
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-7269
Mailing Address - Country:US
Mailing Address - Phone:435-251-2250
Mailing Address - Fax:435-251-2255
Practice Address - Street 1:652 S MEDICAL CENTER DR STE LL10
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-7269
Practice Address - Country:US
Practice Address - Phone:435-251-2250
Practice Address - Fax:435-251-2255
Is Sole Proprietor?:No
Enumeration Date:2016-10-06
Last Update Date:2016-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9823062-4201225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist