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NPI Code Detail

MEDICARE: TAMMY F WILLIAMS-PETRY LISW

MEDICARE: TAMMY F WILLIAMS-PETRY LISW
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
11041C0700XClinical Social WorkerI.0800280OH

General Provider Information

NPI Number : 1972837771
Entity Type Code : Individual
Provider Name (Legal Business Name) : TAMMY F WILLIAMS-PETRY LISW
Provider Business Mailing Address
First Line : 1055 E CENTERVILLE STATION RD
Second Line :
City : DAYTON
State : OH
Zip : 45459-5500
Country : US
Telephone Number : 937-439-2984
Fax Number : 937-439-2984
Provider Business Practice Location Address
First Line : 1055 E CENTERVILLE STATION RD
Second Line :
City : DAYTON
State : OH
Zip : 45459-5500
Country : US
Telephone Number : 937-439-2984
Fax Number : 937-439-2984
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/25/2009
Last Update Date : 12/01/2016

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