Provider Demographics
NPI:1699016121
Name:WILLIAMS, STEVE (CPO)
Entity Type:Individual
Prefix:
First Name:STEVE
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1136 INDEPENDENCE AVE
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:OH
Mailing Address - Zip Code:43302-6318
Mailing Address - Country:US
Mailing Address - Phone:740-383-3490
Mailing Address - Fax:740-383-6549
Practice Address - Street 1:1136 INDEPENDENCE AVE
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302-6318
Practice Address - Country:US
Practice Address - Phone:740-383-3490
Practice Address - Fax:740-383-6549
Is Sole Proprietor?:No
Enumeration Date:2013-03-07
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLPO144222Z00000X, 224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2023885Medicaid