Provider Demographics
NPI:1346478294
Name:WILLIAMS, RACHELLE MARIE (LMP)
Entity Type:Individual
Prefix:
First Name:RACHELLE
Middle Name:MARIE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4215 CONVENTION PL STE B
Mailing Address - Street 2:
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99301-8148
Mailing Address - Country:US
Mailing Address - Phone:509-947-7005
Mailing Address - Fax:509-545-1112
Practice Address - Street 1:4215 CONVENTION PL STE B
Practice Address - Street 2:
Practice Address - City:PASCO
Practice Address - State:WA
Practice Address - Zip Code:99301-8148
Practice Address - Country:US
Practice Address - Phone:509-545-1010
Practice Address - Fax:509-545-1112
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-30
Last Update Date:2009-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00016587225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMA00016587OtherMASSAGE THERAPY LICENSE