Provider Demographics
NPI:1265869879
Name:WILLIAMS, KEONNA MARIE (OTD)
Entity type:Individual
Prefix:
First Name:KEONNA
Middle Name:MARIE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:690 N COFCO CENTER CT STE 260
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85008-6473
Mailing Address - Country:US
Mailing Address - Phone:602-279-6905
Mailing Address - Fax:602-279-6934
Practice Address - Street 1:690 N COFCO CENTER CT STE 260
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85008-6473
Practice Address - Country:US
Practice Address - Phone:602-279-6905
Practice Address - Fax:602-279-6934
Is Sole Proprietor?:No
Enumeration Date:2013-09-27
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5601225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist