Provider Demographics
NPI:1679341796
Name:WILLIAMS, LYDIA MARY (OTR/L)
Entity type:Individual
Prefix:
First Name:LYDIA
Middle Name:MARY
Last Name:WILLIAMS
Suffix:
Gender:F
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 1:1375 BELLEMEADE LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28270-9759
Mailing Address - Country:US
Mailing Address - Phone:980-228-0992
Mailing Address - Fax:
Practice Address - Street 1:600 FULLWOOD RD
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-2659
Practice Address - Country:US
Practice Address - Phone:704-841-4920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-18
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC16497225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist