Provider Demographics
NPI:1417224049
Name:SULTRMEIER WILLIAMS, C DAYNE (OT)
Entity type:Individual
Prefix:
First Name:C
Middle Name:DAYNE
Last Name:SULTRMEIER WILLIAMS
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:PO BOX 416
Mailing Address - Street 2:
Mailing Address - City:CORRALES
Mailing Address - State:NM
Mailing Address - Zip Code:87048-0416
Mailing Address - Country:US
Mailing Address - Phone:505-897-8723
Mailing Address - Fax:505-897-8723
Practice Address - Street 1:212 RANCHO ALONDRA
Practice Address - Street 2:
Practice Address - City:CORRALES
Practice Address - State:NM
Practice Address - Zip Code:87048-7921
Practice Address - Country:US
Practice Address - Phone:505-897-8723
Practice Address - Fax:505-897-8723
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-28
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM820225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist