Provider Demographics
NPI:1396003828
Name:WILLIAMS, MARY L (ATC, LAT)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:L
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:L
Other - Last Name:BARNES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC, LAT
Mailing Address - Street 1:7718 ELK DR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78414-5979
Mailing Address - Country:US
Mailing Address - Phone:361-549-1205
Mailing Address - Fax:
Practice Address - Street 1:6300 OCEAN DR
Practice Address - Street 2:UNIT 5820
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78412-5503
Practice Address - Country:US
Practice Address - Phone:361-825-2169
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-03
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT26332255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer