Provider Demographics
NPI:1598990400
Name:WILLIAMS, TIMOTHY LEON (OTR)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:LEON
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1723 CAROL STREAM DR
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75081-2120
Mailing Address - Country:US
Mailing Address - Phone:972-470-0460
Mailing Address - Fax:
Practice Address - Street 1:1723 CAROL STREAM DR
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75081-2120
Practice Address - Country:US
Practice Address - Phone:972-470-0460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-20
Last Update Date:2009-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX103882225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist