Provider Demographics
NPI:1841436912
Name:WILLIAMS, MICHELE LEE (LMP)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:LEE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:MICHELE
Other - Middle Name:L
Other - Last Name:RAY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMP
Mailing Address - Street 1:PO BOX 342
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:WA
Mailing Address - Zip Code:98353-0342
Mailing Address - Country:US
Mailing Address - Phone:360-876-4171
Mailing Address - Fax:360-876-3495
Practice Address - Street 1:9481 BANNER RD SE
Practice Address - Street 2:
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98367-9748
Practice Address - Country:US
Practice Address - Phone:360-710-8074
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-19
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60059751225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist