Provider Demographics
NPI:1285671586
Name:WILLIAMS, KATHLEEN MONICA (LMT)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:MONICA
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1084 JACKMAR RD
Mailing Address - Street 2:
Mailing Address - City:DUNEDIN
Mailing Address - State:FL
Mailing Address - Zip Code:34698-3501
Mailing Address - Country:US
Mailing Address - Phone:727-512-0161
Mailing Address - Fax:727-736-6611
Practice Address - Street 1:1968 BAYSHORE BLVD
Practice Address - Street 2:
Practice Address - City:DUNEDIN
Practice Address - State:FL
Practice Address - Zip Code:34698-2500
Practice Address - Country:US
Practice Address - Phone:727-738-9333
Practice Address - Fax:727-736-6611
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-02
Last Update Date:2009-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5200225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist