Provider Demographics
NPI:1437559283
Name:WILLIAMS, KESHIA NICOLE (MS, ATC, LAT)
Entity Type:Individual
Prefix:
First Name:KESHIA
Middle Name:NICOLE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MS, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:982B SAINT CLAIR ST
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21742-3133
Mailing Address - Country:US
Mailing Address - Phone:240-925-4871
Mailing Address - Fax:
Practice Address - Street 1:982B SAINT CLAIR ST
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21742-3133
Practice Address - Country:US
Practice Address - Phone:240-925-4871
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-29
Last Update Date:2014-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA00006622255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer