Provider Demographics
NPI:1154423283
Name:WILLM, CARMEN (OT)
Entity type:Individual
Prefix:MS
First Name:CARMEN
Middle Name:
Last Name:WILLM
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2832 BURNEY DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29205-3465
Mailing Address - Country:US
Mailing Address - Phone:803-256-3755
Mailing Address - Fax:803-256-2903
Practice Address - Street 1:1710B RICHLAND ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-2636
Practice Address - Country:US
Practice Address - Phone:803-253-6223
Practice Address - Fax:803-253-6224
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2060225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist