Provider Demographics
NPI:1558898361
Name:WILLIFORD, CECILIA (OTR/L)
Entity Type:Individual
Prefix:
First Name:CECILIA
Middle Name:
Last Name:WILLIFORD
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 HIGH COTTON DR
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30461-0770
Mailing Address - Country:US
Mailing Address - Phone:912-678-5215
Mailing Address - Fax:
Practice Address - Street 1:508 GENTILLY RD
Practice Address - Street 2:
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458-5149
Practice Address - Country:US
Practice Address - Phone:912-681-7768
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT006694225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics