Provider Demographics
NPI:1508467416
Name:ENIX WILLIAMS, DEBORAH BERENICE (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:BERENICE
Last Name:ENIX WILLIAMS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:DEBBIE
Other - Middle Name:B
Other - Last Name:ENIX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1478
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-1478
Mailing Address - Country:US
Mailing Address - Phone:909-645-6840
Mailing Address - Fax:909-799-8214
Practice Address - Street 1:26261 KING EDWARDS DR
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-4158
Practice Address - Country:US
Practice Address - Phone:909-645-6840
Practice Address - Fax:909-799-8214
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-06
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT5382225XE1200X, 225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical RehabilitationGroup - Single Specialty
No225XE1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistErgonomics