Provider Demographics
NPI:1790875078
Name:WILLIAMS, SUE ANN (LMT/COTA)
Entity Type:Individual
Prefix:MS
First Name:SUE
Middle Name:ANN
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LMT/COTA
Other - Prefix:MRS
Other - First Name:SUE
Other - Middle Name:ANN
Other - Last Name:ROBB/DIEBOLD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT/COTA
Mailing Address - Street 1:433 NORTH MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:WARSAW
Mailing Address - State:NY
Mailing Address - Zip Code:14569
Mailing Address - Country:US
Mailing Address - Phone:585-727-6480
Mailing Address - Fax:585-786-2465
Practice Address - Street 1:433 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:NY
Practice Address - Zip Code:14569-1029
Practice Address - Country:US
Practice Address - Phone:585-727-6480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-15
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003716-1224Z00000X
NY013922-1225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY27025601OtherUNIVERA