Provider Demographics
NPI:1922137249
Name:WILLIAMS, AMANDA (OT)
Entity Type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3960 BELL RD
Mailing Address - Street 2:APT 1206
Mailing Address - City:HERMITAGE
Mailing Address - State:TN
Mailing Address - Zip Code:37076-2944
Mailing Address - Country:US
Mailing Address - Phone:616-975-2868
Mailing Address - Fax:615-871-9805
Practice Address - Street 1:3960 BELL RD
Practice Address - Street 2:APT 1206
Practice Address - City:HERMITAGE
Practice Address - State:TN
Practice Address - Zip Code:37076-2944
Practice Address - Country:US
Practice Address - Phone:616-975-2868
Practice Address - Fax:615-871-9805
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPSS164251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN894OtherOTLICENSE