Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2251E1200X | Ergonomics | OT5382 | CA |
N | 225XE1200X | Ergonomics | OT5382 | CA |
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | OT5382 | CA |
NPI | 1508467416 |
---|---|
Provider Name | Ms. Deborah Berenice Enix Williams |
First Address | Loma Linda, CA 92354-1478 |
Second Address | Loma Linda, CA 92354-4158 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/11/2020 |
Last Update Date | 06/11/2020 |