Provider Demographics
NPI:1629381074
Name:WILLIAMS, LORA ANN (LMT,)
Entity Type:Individual
Prefix:
First Name:LORA
Middle Name:ANN
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 1:9571 ABINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48227-1001
Mailing Address - Country:US
Mailing Address - Phone:615-423-9520
Mailing Address - Fax:
Practice Address - Street 1:19992 FARMINGTON RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-1409
Practice Address - Country:US
Practice Address - Phone:877-725-5672
Practice Address - Fax:877-725-5672
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-14
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501011378225700000X
TN0000007163171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist