Provider Demographics
NPI:1518287861
Name:WILLIAMS, CHERYL LYNN (OTR/L, MED)
Entity Type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:LYNN
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:OTR/L, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6520 THIRD STREET
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955
Mailing Address - Country:US
Mailing Address - Phone:321-622-8792
Mailing Address - Fax:321-622-8793
Practice Address - Street 1:3305 S. ORANGE AVE.
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806
Practice Address - Country:US
Practice Address - Phone:407-277-5400
Practice Address - Fax:321-281-4942
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-09
Last Update Date:2019-08-16
Deactivation Date:2019-07-29
Deactivation Code:
Reactivation Date:2019-08-16
Provider Licenses
StateLicense IDTaxonomies
FLOT20157225X00000X
FLOT 10594225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002354100Medicaid