Provider Demographics
NPI:1578193272
Name:WILLIAMS, WHITNEY SHANNON (ATC)
Entity Type:Individual
Prefix:MS
First Name:WHITNEY
Middle Name:SHANNON
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 1/2 N SUPERIOR ST APT 1
Mailing Address - Street 2:
Mailing Address - City:ALBION
Mailing Address - State:MI
Mailing Address - Zip Code:49224-1742
Mailing Address - Country:US
Mailing Address - Phone:262-719-9320
Mailing Address - Fax:
Practice Address - Street 1:611 E PORTER ST
Practice Address - Street 2:
Practice Address - City:ALBION
Practice Address - State:MI
Practice Address - Zip Code:49224-1887
Practice Address - Country:US
Practice Address - Phone:517-629-0580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-22
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI26010021592255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer