Provider Demographics
NPI:1699350058
Name:WILLIAMS, AMBER DAWN (COTA/L)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:DAWN
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:DAWN
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:COTA/L
Mailing Address - Street 1:801 EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:CAMERON
Mailing Address - State:MO
Mailing Address - Zip Code:64429-2003
Mailing Address - Country:US
Mailing Address - Phone:816-632-7254
Mailing Address - Fax:
Practice Address - Street 1:801 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CAMERON
Practice Address - State:MO
Practice Address - Zip Code:64429-2003
Practice Address - Country:US
Practice Address - Phone:816-632-7254
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-16
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015002142224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant