MEDICARE: KATHLEEN MONICA WILLIAMS LMT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	5200	FL

General Provider Information

NPI Number	:	1285671586
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLEEN MONICA WILLIAMS LMT

Provider Business Mailing Address
First Line	:	1084 JACKMAR RD
Second Line	:
City	:	DUNEDIN
State	:	FL
Zip	:	34698-3501
Country	:	US
Telephone Number	:	727-512-0161
Fax Number	:	727-736-6611

Provider Business Practice Location Address
First Line	:	1968 BAYSHORE BLVD
Second Line	:
City	:	DUNEDIN
State	:	FL
Zip	:	34698-2500
Country	:	US
Telephone Number	:	727-738-9333
Fax Number	:	727-736-6611

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/02/2006
Last Update Date	:	08/10/2009

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