Provider Demographics
NPI:1427450600
Name:WILLIAMS, JOLENE (COTA/L)
Entity type:Individual
Prefix:MRS
First Name:JOLENE
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10015 OLD COLUMBIA RD
Mailing Address - Street 2:SUITE G-118
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21046-1703
Mailing Address - Country:US
Mailing Address - Phone:410-997-8081
Mailing Address - Fax:410-997-8082
Practice Address - Street 1:10015 OLD COLUMBIA RD
Practice Address - Street 2:SUITE G-118
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21046-1703
Practice Address - Country:US
Practice Address - Phone:410-997-8081
Practice Address - Fax:410-997-8082
Is Sole Proprietor?:No
Enumeration Date:2014-09-19
Last Update Date:2014-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA01378224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant