Provider Demographics
NPI:1528598547
Name:WILLIAMS, CALEB SHALOM
Entity Type:Individual
Prefix:
First Name:CALEB
Middle Name:SHALOM
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3825 COUNTRYSIDE BLVD N
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34684-4928
Mailing Address - Country:US
Mailing Address - Phone:727-408-5125
Mailing Address - Fax:
Practice Address - Street 1:3825 COUNTRYSIDE BLVD N
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684-4928
Practice Address - Country:US
Practice Address - Phone:727-408-5125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA14600224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant