Provider Demographics
NPI:1457112914
Name:WILLIAMS, AUTUMN AVE TRECIA DONTE
Entity Type:Individual
Prefix:
First Name:AUTUMN
Middle Name:AVE TRECIA DONTE
Last Name: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 1:3322 MILLVALE AVE NE UNIT 2
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44705-4948
Mailing Address - Country:US
Mailing Address - Phone:330-313-2577
Mailing Address - Fax:
Practice Address - Street 1:3322 MILLVALE AVE NE UNIT 2
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44705-4948
Practice Address - Country:US
Practice Address - Phone:330-313-2577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-22
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide