Provider Demographics
NPI:1649832064
Name:WILLIAMS, BRANDON MARCEL (OTR/L)
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:MARCEL
Last Name:WILLIAMS
Suffix:
Gender:M
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 1:110 PARKWAY DR
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31792-6747
Mailing Address - Country:US
Mailing Address - Phone:229-225-8761
Mailing Address - Fax:
Practice Address - Street 1:3155 N POINT PKWY STE D100
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-5700
Practice Address - Country:US
Practice Address - Phone:770-475-7272
Practice Address - Fax:770-475-7270
Is Sole Proprietor?:No
Enumeration Date:2019-07-05
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL19924225XH1200X
GAOT007353225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand