Provider Demographics
NPI:1902953250
Name:WILLIAMSON, LYNDA (OTRL, CHT)
Entity Type:Individual
Prefix:
First Name:LYNDA
Middle Name:
Last Name:WILLIAMSON
Suffix:
Gender:F
Credentials:OTRL, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:708 S RACE ST
Mailing Address - Street 2:STE C
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98362-6441
Mailing Address - Country:US
Mailing Address - Phone:360-417-0703
Mailing Address - Fax:360-417-2007
Practice Address - Street 1:708 S RACE ST
Practice Address - Street 2:STE C
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98362-6441
Practice Address - Country:US
Practice Address - Phone:360-417-0703
Practice Address - Fax:360-417-2007
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT00001560225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAWI4585OtherREGENCE BC BS ID
WA912166024-01OtherKPS ID
WA8327736Medicaid
WA0099430OtherWA ST L&I
WA912166024-01OtherKPS ID