Provider Demographics
NPI:1962652370
Name:WILLIAMS, TAMALYN JOE (LMP)
Entity Type:Individual
Prefix:
First Name:TAMALYN
Middle Name:JOE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1240 RUDDELL RD SE
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-5753
Mailing Address - Country:US
Mailing Address - Phone:360-491-1232
Mailing Address - Fax:360-491-1494
Practice Address - Street 1:1240 RUDDELL RD SE
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-5753
Practice Address - Country:US
Practice Address - Phone:360-491-1232
Practice Address - Fax:360-491-1494
Is Sole Proprietor?:No
Enumeration Date:2008-09-22
Last Update Date:2008-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60025097174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist