Provider Demographics
NPI:1639162357
Name:WILLIAMS, SHAWN M (OT)
Entity Type:Individual
Prefix:MR
First Name:SHAWN
Middle Name:M
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34406 N 27TH DR
Mailing Address - Street 2:STE 140
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85085-6079
Mailing Address - Country:US
Mailing Address - Phone:623-444-8880
Mailing Address - Fax:623-444-9282
Practice Address - Street 1:34406 N 27TH DR
Practice Address - Street 2:STE 140
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85085-6079
Practice Address - Country:US
Practice Address - Phone:623-444-8880
Practice Address - Fax:623-444-9282
Is Sole Proprietor?:No
Enumeration Date:2005-08-29
Last Update Date:2018-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2491174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ007171346OtherAETNA
AZAZ0310170OtherBCBS
AZ501032Medicaid
AZ501032Medicaid