Provider Demographics
NPI:1285978734
Name:WILLIAMS, KEVIN SCOTT (COTA/L)
Entity type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:SCOTT
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:28945 HOFFMAN RD
Mailing Address - Street 2:
Mailing Address - City:MARSTON
Mailing Address - State:NC
Mailing Address - Zip Code:28363-8131
Mailing Address - Country:US
Mailing Address - Phone:910-277-9103
Mailing Address - Fax:
Practice Address - Street 1:310 E WARDELL DR
Practice Address - Street 2:
Practice Address - City:PEMBROKE
Practice Address - State:NC
Practice Address - Zip Code:28372-7997
Practice Address - Country:US
Practice Address - Phone:910-521-1273
Practice Address - Fax:910-521-3593
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-22
Last Update Date:2012-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0832224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant