Provider Demographics
NPI:1710769815
Name:WILLIAMS, SHELLEY-ANNE (MSOT, OTR/L)
Entity Type:Individual
Prefix:
First Name:SHELLEY-ANNE
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MSOT, OTR/L
Other - Prefix:
Other - First Name:SHELLEY
Other - Middle Name:
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSOT, OTR/L
Mailing Address - Street 1:PO BOX 452825
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33345-2825
Mailing Address - Country:US
Mailing Address - Phone:954-609-5564
Mailing Address - Fax:
Practice Address - Street 1:7278 NW 47TH PL
Practice Address - Street 2:
Practice Address - City:LAUDERHILL
Practice Address - State:FL
Practice Address - Zip Code:33319-3412
Practice Address - Country:US
Practice Address - Phone:954-609-5564
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-16
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT24334225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLOT24334OtherOCCUPATIONAL THERAPY LICENSE