Provider Demographics
NPI:1093952699
Name:WILLIAMS, KEVIN D (LMP)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:D
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 25723
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98165-1223
Mailing Address - Country:US
Mailing Address - Phone:206-290-0320
Mailing Address - Fax:
Practice Address - Street 1:810 NE 106TH ST
Practice Address - Street 2:6
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98125-7348
Practice Address - Country:US
Practice Address - Phone:206-290-0320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-20
Last Update Date:2009-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60070381225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMA60070381OtherWASHINGTON STATE DEPT. OF HEALTH