Provider Demographics
NPI:1396576096
Name:WILLIAMS, GILLIAN KARLENE (MSOT)
Entity type:Individual
Prefix:
First Name:GILLIAN
Middle Name:KARLENE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MSOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8811 NW 78TH ST APT 175
Mailing Address - Street 2:
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-2000
Mailing Address - Country:US
Mailing Address - Phone:754-292-7916
Mailing Address - Fax:
Practice Address - Street 1:8811 NW 78TH ST APT 175
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-2000
Practice Address - Country:US
Practice Address - Phone:754-292-7916
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-13
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL24236225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist