Provider Demographics
NPI:1609353580
Name:WILLIAMS, ALICIA GENE
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:GENE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3317 52ND PL NE
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98422-4522
Mailing Address - Country:US
Mailing Address - Phone:253-250-6484
Mailing Address - Fax:
Practice Address - Street 1:1520 ASHBERRY CT APT 1
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-8355
Practice Address - Country:US
Practice Address - Phone:253-250-6484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-24
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer