Provider Demographics
NPI:1922670942
Name:WILLIAMS, TABITHA SARAI (LMT,MMP)
Entity Type:Individual
Prefix:
First Name:TABITHA
Middle Name:SARAI
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LMT,MMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:808 PEBBLE CREEK CT
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:TN
Mailing Address - Zip Code:37013-1872
Mailing Address - Country:US
Mailing Address - Phone:870-551-1326
Mailing Address - Fax:
Practice Address - Street 1:808 PEBBLE CREEK CT
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:TN
Practice Address - Zip Code:37013-3701
Practice Address - Country:US
Practice Address - Phone:870-551-1326
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-11
Last Update Date:2021-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN11958225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist