Provider Demographics
NPI:1982626032
Name:WILLIAMS, MICKI L (RPT)
Entity Type:Individual
Prefix:
First Name:MICKI
Middle Name:L
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:MICKI
Other - Middle Name:L
Other - Last Name:BEACHLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPT
Mailing Address - Street 1:P.O. BOX 141
Mailing Address - Street 2:
Mailing Address - City:URBANA
Mailing Address - State:MO
Mailing Address - Zip Code:65767
Mailing Address - Country:US
Mailing Address - Phone:417-993-4670
Mailing Address - Fax:
Practice Address - Street 1:204 SEMINARY ST.
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:MO
Practice Address - Zip Code:65355
Practice Address - Country:US
Practice Address - Phone:660-438-6993
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO111525225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO266598Medicare ID - Type Unspecified