Provider Demographics
NPI:1902146251
Name:WILLIAMS, PAULETTE RICHARDSON (OT)
Entity Type:Individual
Prefix:MRS
First Name:PAULETTE
Middle Name:RICHARDSON
Last Name: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 1:320 WILLWAY DR
Mailing Address - Street 2:
Mailing Address - City:MANAKIN SABOT
Mailing Address - State:VA
Mailing Address - Zip Code:23103-3281
Mailing Address - Country:US
Mailing Address - Phone:804-784-1986
Mailing Address - Fax:
Practice Address - Street 1:320 WILLWAY DR
Practice Address - Street 2:
Practice Address - City:MANAKIN SABOT
Practice Address - State:VA
Practice Address - Zip Code:23103-3281
Practice Address - Country:US
Practice Address - Phone:804-784-1986
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-24
Last Update Date:2013-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119003220225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist