Provider Demographics
NPI:1639162357
Name:WILLIAMS, SHAWN M (OT)
Entity type:Individual
Prefix:MR
First Name:SHAWN
Middle Name:M
Last Name:WILLIAMS
Suffix:
Gender:
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20783 N 83RD AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-7430
Mailing Address - Country:US
Mailing Address - Phone:623-444-8880
Mailing Address - Fax:623-444-9282
Practice Address - Street 1:20783 N 83RD AVE STE 103
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-7430
Practice Address - Country:US
Practice Address - Phone:623-444-8880
Practice Address - Fax:623-444-9282
Is Sole Proprietor?:No
Enumeration Date:2005-08-29
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2491174400000X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ007171346OtherAETNA
AZAZ0310170OtherBCBS
AZ501032Medicaid
AZ501032Medicaid