Provider Demographics
NPI:1902117096
Name:WILLIAMS, JUSTIN BANKS (OTD, MS, OTR/L, PM)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:BANKS
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:OTD, MS, OTR/L, PM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 SPRINGCREST CT
Mailing Address - Street 2:GENESIS REHAB SERVICES
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-4034
Mailing Address - Country:US
Mailing Address - Phone:864-528-5546
Mailing Address - Fax:
Practice Address - Street 1:10 FOUNTAINVIEW TER
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-4033
Practice Address - Country:US
Practice Address - Phone:864-233-6367
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-23
Last Update Date:2014-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3679225XG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontology