Provider Demographics
NPI:1295430809
Name:WILLIAMS, LAEKAN (COTA/L)
Entity type:Individual
Prefix:
First Name:LAEKAN
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:LAEKAN
Other - Middle Name:
Other - Last Name:WILBURN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1393 DOW ST
Mailing Address - Street 2:
Mailing Address - City:CHRISTIANSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24073-2854
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:159 HARTLEY WAY
Practice Address - Street 2:
Practice Address - City:PEARISBURG
Practice Address - State:VA
Practice Address - Zip Code:24134-2471
Practice Address - Country:US
Practice Address - Phone:540-921-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-03
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0131002454224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant