Provider Demographics
NPI:1598963530
Name:WILLIAMS, STEPHEN O (RPT)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:O
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1525 MICHIGAN AVE W
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49037-1947
Mailing Address - Country:US
Mailing Address - Phone:269-565-1080
Mailing Address - Fax:269-565-1082
Practice Address - Street 1:1525 MICHIGAN AVE W
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49037-1947
Practice Address - Country:US
Practice Address - Phone:269-565-1080
Practice Address - Fax:269-565-1082
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MISW006847225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4461070Medicaid
MIS92872Medicare UPIN
MI4461070Medicaid