Provider Demographics
NPI:1104011899
Name:WILLIAMS, BILLY SHANE (COTA/L)
Entity type:Individual
Prefix:MR
First Name:BILLY
Middle Name:SHANE
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1034
Mailing Address - Street 2:
Mailing Address - City:CARBON HILL
Mailing Address - State:AL
Mailing Address - Zip Code:35549-1034
Mailing Address - Country:US
Mailing Address - Phone:205-924-8188
Mailing Address - Fax:205-924-8870
Practice Address - Street 1:5TH STREET AND 4TH AVE
Practice Address - Street 2:
Practice Address - City:CARBON HILL
Practice Address - State:AL
Practice Address - Zip Code:35549
Practice Address - Country:US
Practice Address - Phone:205-924-8188
Practice Address - Fax:205-924-8870
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-06
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1831224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant