Provider Demographics
NPI:1427137272
Name:WILLIAMS, MARIE ANN (LMP CCP)
Entity type:Individual
Prefix:MS
First Name:MARIE
Middle Name:ANN
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LMP CCP
Other - Prefix:MRS
Other - First Name:MARIE
Other - Middle Name:ANN
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:26909 NE 45TH ST
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98053
Mailing Address - Country:US
Mailing Address - Phone:425-868-7035
Mailing Address - Fax:425-868-7035
Practice Address - Street 1:13904 100TH AVE NE
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-5231
Practice Address - Country:US
Practice Address - Phone:425-820-5888
Practice Address - Fax:425-820-5022
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00007057225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist