Provider Demographics
NPI:1851627392
Name:WILLIAMSON, HEATHER
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:WILLIAMSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 TANDEM LN
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:CT
Mailing Address - Zip Code:06784-1918
Mailing Address - Country:US
Mailing Address - Phone:203-788-6402
Mailing Address - Fax:
Practice Address - Street 1:12 TANDEM LN
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:CT
Practice Address - Zip Code:06784-1918
Practice Address - Country:US
Practice Address - Phone:203-788-6402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-18
Last Update Date:2009-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002510225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist