Provider Demographics
NPI:1679500474
Name:WILLIAMS, SANDRA LEE (ATC)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:LEE
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 1:854 CEDAR GROVE RD
Mailing Address - Street 2:
Mailing Address - City:COXS CREEK
Mailing Address - State:KY
Mailing Address - Zip Code:40013-7564
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:BEREA COLLEGE
Practice Address - Street 2:CPO 2093
Practice Address - City:BEREA
Practice Address - State:KY
Practice Address - Zip Code:40404-0001
Practice Address - Country:US
Practice Address - Phone:859-985-3421
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer