Provider Demographics
NPI:1306056221
Name:MARY K. WILLIAMS
Entity type:Organization
Organization Name:MARY K. WILLIAMS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:KATHRYN
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:503-246-7800
Mailing Address - Street 1:1509 SW SUNSET BLVD
Mailing Address - Street 2:SUITE 1K
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-2692
Mailing Address - Country:US
Mailing Address - Phone:503-246-7800
Mailing Address - Fax:503-246-7801
Practice Address - Street 1:1509 SW SUNSET BLVD
Practice Address - Street 2:SUITE 1K
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-2692
Practice Address - Country:US
Practice Address - Phone:503-246-7800
Practice Address - Fax:503-246-7801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR280552174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR=========Medicare UPIN