Provider Demographics
NPI:1932672193
Name:WILLIAMS, MISTY RENEE (COMS)
Entity Type:Individual
Prefix:MS
First Name:MISTY
Middle Name:RENEE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:COMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 THORNWOOD DR
Mailing Address - Street 2:
Mailing Address - City:TAYLORS
Mailing Address - State:SC
Mailing Address - Zip Code:29687-3447
Mailing Address - Country:US
Mailing Address - Phone:864-376-9526
Mailing Address - Fax:
Practice Address - Street 1:301 THORNWOOD DR
Practice Address - Street 2:
Practice Address - City:TAYLORS
Practice Address - State:SC
Practice Address - Zip Code:29687-3447
Practice Address - Country:US
Practice Address - Phone:864-376-9526
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-09
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC22408225CX0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225CX0006XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation CounselorOrientation and Mobility Training Provider