Provider Demographics
NPI:1902238017
Name:WILLIAMS, PATRICK MARIO (OTA)
Entity Type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:MARIO
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:OTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3520 E F ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98404-2134
Mailing Address - Country:US
Mailing Address - Phone:253-307-1286
Mailing Address - Fax:
Practice Address - Street 1:301 OLD HIGHWAY 99 NORTH
Practice Address - Street 2:
Practice Address - City:TENINO
Practice Address - State:WA
Practice Address - Zip Code:98589
Practice Address - Country:US
Practice Address - Phone:360-264-3700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-31
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOC60335871224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant