Provider Demographics
NPI:1457558991
Name:WILLIAMS, MELISSA (OT)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2991 SPRAGUE ST
Mailing Address - Street 2:
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98366-4932
Mailing Address - Country:US
Mailing Address - Phone:360-337-7422
Mailing Address - Fax:360-698-7488
Practice Address - Street 1:2321 NW SCHOLD PL
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-9504
Practice Address - Country:US
Practice Address - Phone:360-337-7422
Practice Address - Fax:360-698-7488
Is Sole Proprietor?:No
Enumeration Date:2007-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAWILLIMH200CE225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA505484Medicare ID - Type Unspecified