Provider Demographics
NPI:1750119533
Name:WILLIAMS, KASSIE ANNE (MS, OTR/L)
Entity type:Individual
Prefix:
First Name:KASSIE
Middle Name:ANNE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:817 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28115-2315
Mailing Address - Country:US
Mailing Address - Phone:980-622-0006
Mailing Address - Fax:
Practice Address - Street 1:2110 BEN CRAIG DR STE 300
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-2302
Practice Address - Country:US
Practice Address - Phone:704-595-9363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-23
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC16786225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist