Provider Demographics
NPI:1457380354
Name:MCWILLIAMS, JANINE M (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:JANINE
Middle Name:M
Last Name:MCWILLIAMS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:PA
Mailing Address - Zip Code:17752
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:43 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:PA
Practice Address - Zip Code:17752-1120
Practice Address - Country:US
Practice Address - Phone:570-547-0480
Practice Address - Fax:570-547-0498
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC009800225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA267185OtherHEALTH AMERICA
PA1766881OtherHIGHMARK BLUE SHIELD
PA50054302OtherKHPC/ SR BLUE
PA101376156000Medicaid