Provider Demographics
NPI:1649587882
Name:WILLIAMS, ANGIE CAMERON (OTR)
Entity type:Individual
Prefix:
First Name:ANGIE
Middle Name:CAMERON
Last Name:WILLIAMS
Suffix:
Gender:
Credentials:OTR
Other - Prefix:
Other - First Name:ANGIE
Other - Middle Name:CAMERON
Other - Last Name:HANCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:325 W MORRIS BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37813-2237
Mailing Address - Country:US
Mailing Address - Phone:423-375-8907
Mailing Address - Fax:423-822-5514
Practice Address - Street 1:113 HEDRICK DR
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:TN
Practice Address - Zip Code:37821-2930
Practice Address - Country:US
Practice Address - Phone:423-438-1124
Practice Address - Fax:423-244-0279
Is Sole Proprietor?:No
Enumeration Date:2010-09-09
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4266225X00000X
TN2605225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant