Provider Demographics
NPI:1184758732
Name:WILLIAMS, SHELLEY THERESA (OTR)
Entity type:Individual
Prefix:
First Name:SHELLEY
Middle Name:THERESA
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9505 STONEMEADOW CT
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-3880
Mailing Address - Country:US
Mailing Address - Phone:804-261-6999
Mailing Address - Fax:
Practice Address - Street 1:2300 CEDARFIELD PKWY
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23233-1936
Practice Address - Country:US
Practice Address - Phone:804-474-8844
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119001324225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist