Provider Demographics
NPI:1720277510
Name:WILLIAMS, MARC ANTHONY (OTD, OTR/L)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:ANTHONY
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13355 US N HWY 183, APT 1127
Mailing Address - Street 2:APT. 308
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78750
Mailing Address - Country:US
Mailing Address - Phone:832-714-1088
Mailing Address - Fax:
Practice Address - Street 1:615 FAIRWAY DR
Practice Address - Street 2:APT. 308
Practice Address - City:SAINT AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32084-3816
Practice Address - Country:US
Practice Address - Phone:941-769-0396
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-17
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL12878225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist