Provider Demographics
NPI:1710905500
Name:MOTLEY-WILLIAMS, THERESA MONIQUE
Entity Type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:MONIQUE
Last Name:MOTLEY-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 1:6 HOWARD CT
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44303-2216
Mailing Address - Country:US
Mailing Address - Phone:330-384-9262
Mailing Address - Fax:
Practice Address - Street 1:6 HOWARD CT
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44303-2216
Practice Address - Country:US
Practice Address - Phone:330-384-9262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2169648Medicaid