Provider Demographics
NPI:1578763280
Name:WILLIAMS, CATHERINE DENISE (LMT)
Entity Type:Individual
Prefix:MRS
First Name:CATHERINE
Middle Name:DENISE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LAKE BUTLER
Mailing Address - State:FL
Mailing Address - Zip Code:32054-1331
Mailing Address - Country:US
Mailing Address - Phone:386-496-1347
Mailing Address - Fax:386-496-1247
Practice Address - Street 1:620 E MAIN ST
Practice Address - Street 2:
Practice Address - City:LAKE BUTLER
Practice Address - State:FL
Practice Address - Zip Code:32054-1331
Practice Address - Country:US
Practice Address - Phone:386-496-1347
Practice Address - Fax:386-496-1247
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-20
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA49080225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist