Provider Demographics
NPI:1962803379
Name:WILLIAMS, NATALIE JACKSON (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:NATALIE
Middle Name:JACKSON
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3612 CARROLLWOOD PLACE CIR
Mailing Address - Street 2:APARTMENT 202
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33624-3068
Mailing Address - Country:US
Mailing Address - Phone:813-240-1942
Mailing Address - Fax:
Practice Address - Street 1:3612 CARROLLWOOD PLACE CIR
Practice Address - Street 2:APARTMENT 202
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33624-3068
Practice Address - Country:US
Practice Address - Phone:813-240-1942
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-05
Last Update Date:2014-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT14226225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist