Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 701 | CO |
NPI | 1023360252 |
---|---|
Provider Name | Shannon Williams |
First Address | Denver, CO 80211-3601 |
Second Address | Denver, CO 80211-3601 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2012 |
Last Update Date | 11/10/2012 |