Provider Demographics
NPI:1306464714
Name:WILLIAMS, JORDAN (MS OTR/L)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
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 1:91 LULL RD
Mailing Address - Street 2:
Mailing Address - City:WEARE
Mailing Address - State:NH
Mailing Address - Zip Code:03281
Mailing Address - Country:US
Mailing Address - Phone:603-540-8769
Mailing Address - Fax:
Practice Address - Street 1:91 LULL RD
Practice Address - Street 2:
Practice Address - City:WEARE
Practice Address - State:NH
Practice Address - Zip Code:03281
Practice Address - Country:US
Practice Address - Phone:603-540-8769
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-13
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH2998225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist