Provider Demographics
NPI:1649440199
Name:WILLIAMS, KRISTIE (MOTR/L)
Entity type:Individual
Prefix:
First Name:KRISTIE
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5119 SALEM TPKE NW
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24017-4666
Mailing Address - Country:US
Mailing Address - Phone:304-920-5093
Mailing Address - Fax:
Practice Address - Street 1:341 MAIN ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24541-1200
Practice Address - Country:US
Practice Address - Phone:434-799-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-11
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV994225X00000X
VA0119004347225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV7505030000Medicaid