Provider Demographics
NPI:1679623227
Name:WILLIAMS, MADONNA P (OTR)
Entity Type:Individual
Prefix:
First Name:MADONNA
Middle Name:P
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2987 RIDERS PASS
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:FL
Mailing Address - Zip Code:33556-3123
Mailing Address - Country:US
Mailing Address - Phone:727-687-6958
Mailing Address - Fax:727-375-2924
Practice Address - Street 1:2987 RIDERS PASS
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:FL
Practice Address - Zip Code:33556-3123
Practice Address - Country:US
Practice Address - Phone:727-687-6958
Practice Address - Fax:727-375-2924
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2020-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT 5996225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL886046700Medicaid