Provider Demographics
NPI:1689277402
Name:MARRONE-WILLIAMS, KIM IRENE (LMT)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:IRENE
Last Name:MARRONE-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 1:295 BARBADOS DR
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-2930
Mailing Address - Country:US
Mailing Address - Phone:845-489-3224
Mailing Address - Fax:
Practice Address - Street 1:295 BARBADOS DR
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-2930
Practice Address - Country:US
Practice Address - Phone:845-489-3224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-17
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYMA54993225700000X
FLMA54993225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist