Provider Demographics
NPI:1306139902
Name:WILLIAMS, MARK SLOAN (MS OTR/L)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:SLOAN
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:MS OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1236 OVERBROOK RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23220-1417
Mailing Address - Country:US
Mailing Address - Phone:336-831-4981
Mailing Address - Fax:
Practice Address - Street 1:235 DUNLOP FARMS BLVD
Practice Address - Street 2:
Practice Address - City:COLONIAL HEIGHTS
Practice Address - State:VA
Practice Address - Zip Code:23834-1792
Practice Address - Country:US
Practice Address - Phone:804-520-0050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-16
Last Update Date:2011-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119005371225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist