Provider Demographics
NPI:1407183791
Name:WILLIAMS, SHARLA DAWN (LMT, CNMT)
Entity Type:Individual
Prefix:MRS
First Name:SHARLA
Middle Name:DAWN
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LMT, CNMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12709 NIGHTSHADE PL
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD RANCH
Mailing Address - State:FL
Mailing Address - Zip Code:34202-2819
Mailing Address - Country:US
Mailing Address - Phone:941-915-4462
Mailing Address - Fax:
Practice Address - Street 1:12709 NIGHTSHADE PL
Practice Address - Street 2:
Practice Address - City:LAKEWOOD RANCH
Practice Address - State:FL
Practice Address - Zip Code:34202-2819
Practice Address - Country:US
Practice Address - Phone:941-915-4462
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-09
Last Update Date:2009-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA55918225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist