Provider Demographics
NPI:1609947100
Name:WILLIAMS, JACLYN ANN (PTA)
Entity Type:Individual
Prefix:MRS
First Name:JACLYN
Middle Name:ANN
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:JACLYN
Other - Middle Name:ANN
Other - Last Name:COLEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:18109 PRINCE PHILIP DR
Mailing Address - Street 2:
Mailing Address - City:OLNEY
Mailing Address - State:MD
Mailing Address - Zip Code:20832-1519
Mailing Address - Country:US
Mailing Address - Phone:301-260-3280
Mailing Address - Fax:301-260-3279
Practice Address - Street 1:18109 PRINCE PHILIP DR
Practice Address - Street 2:SUITE 155
Practice Address - City:OLNEY
Practice Address - State:MD
Practice Address - Zip Code:20832-1519
Practice Address - Country:US
Practice Address - Phone:301-570-3138
Practice Address - Fax:301-570-3139
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA3011225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant