Provider Demographics
NPI:1689886533
Name:WILLARD, JOE F (OTRL)
Entity Type:Individual
Prefix:MR
First Name:JOE
Middle Name:F
Last Name:WILLARD
Suffix:
Gender:M
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2811 DR JOHN HAYNES DR
Mailing Address - Street 2:
Mailing Address - City:PELL CITY
Mailing Address - State:AL
Mailing Address - Zip Code:35125-1447
Mailing Address - Country:US
Mailing Address - Phone:205-884-7202
Mailing Address - Fax:
Practice Address - Street 1:2811 DR JOHN HAYNES DR
Practice Address - Street 2:
Practice Address - City:PELL CITY
Practice Address - State:AL
Practice Address - Zip Code:35125-1447
Practice Address - Country:US
Practice Address - Phone:205-884-7202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL0967225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL515-38619OtherCFI BCBS
AL515-10960OtherSCR BCBS
AL515-38620OtherMCB BCBS
AL515-38620OtherMCB BCBS