Provider Demographics
NPI:1720363484
Name:WILLIAMS, CHRISTOPHER MICHAEL (COTA,/L)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:MICHAEL
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:COTA,/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:227 W 22ND ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16502-2614
Mailing Address - Country:US
Mailing Address - Phone:724-588-3299
Mailing Address - Fax:
Practice Address - Street 1:1952 W 33RD ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16508-2006
Practice Address - Country:US
Practice Address - Phone:724-588-3299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-13
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP003292L224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant