Provider Demographics
NPI:1619925351
Name:WILLIAMSON, CRAIG LEE (MS OT)
Entity Type:Individual
Prefix:MR
First Name:CRAIG
Middle Name:LEE
Last Name:WILLIAMSON
Suffix:
Gender:M
Credentials:MS OT
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:114 MAINE ST STE 8
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:ME
Mailing Address - Zip Code:04011-2029
Mailing Address - Country:US
Mailing Address - Phone:207-415-9514
Mailing Address - Fax:207-207-8664
Practice Address - Street 1:114 MAINE ST STE 8
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011-2029
Practice Address - Country:US
Practice Address - Phone:207-415-9514
Practice Address - Fax:207-721-8664
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-05
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOT1060225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
5652638OtherAETNA PPO
6404211OtherUNITED HEALTHCARE
2071305OtherAETNA HMO
MN22431OtherHARVARD PILGRIM
123152500OtherDEPT OF LABOR ACS
025800OtherANTHEM
123152500OtherDEPT OF LABOR ACS