Provider Demographics
NPI:1902016819
Name:WILLIAMS, CAROL JOY (RPTA)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:JOY
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:RPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 HICKORY DR
Mailing Address - Street 2:
Mailing Address - City:HENRYETTA
Mailing Address - State:OK
Mailing Address - Zip Code:74437-1821
Mailing Address - Country:US
Mailing Address - Phone:918-650-2943
Mailing Address - Fax:918-652-7857
Practice Address - Street 1:403 HICKORY DR
Practice Address - Street 2:
Practice Address - City:HENRYETTA
Practice Address - State:OK
Practice Address - Zip Code:74437-1821
Practice Address - Country:US
Practice Address - Phone:918-650-2943
Practice Address - Fax:918-652-7857
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK235225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant