Provider Demographics
NPI:1649463944
Name:WILLIAMS, MICHAEL ANDREW (OTR/L)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ANDREW
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 1:245 CAHABA VALLEY PKWY STE 200
Mailing Address - Street 2:TRINITY REHAB
Mailing Address - City:PELHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35124-2217
Mailing Address - Country:US
Mailing Address - Phone:205-314-7227
Mailing Address - Fax:205-314-7222
Practice Address - Street 1:500 SPANISH FORT BLVD
Practice Address - Street 2:TRINITY REHAB
Practice Address - City:SPANISH FORT
Practice Address - State:AL
Practice Address - Zip Code:36527-5018
Practice Address - Country:US
Practice Address - Phone:251-626-8526
Practice Address - Fax:251-626-4378
Is Sole Proprietor?:No
Enumeration Date:2007-08-21
Last Update Date:2015-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2979225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09014160Medicaid
MS256542Medicare PIN