Provider Demographics
NPI:1841036258
Name:WILLIAMS, TERI-ANN DANIELLE (BTR, CTRS)
Entity type:Individual
Prefix:
First Name:TERI-ANN
Middle Name:DANIELLE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:BTR, CTRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5131 DUGDALE RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32210-7109
Mailing Address - Country:US
Mailing Address - Phone:786-685-6006
Mailing Address - Fax:
Practice Address - Street 1:5131 DUGDALE RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210-7109
Practice Address - Country:US
Practice Address - Phone:786-685-6006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-04
Last Update Date:2024-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
69268225800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist