Healthcare Provider Details

I. General information

NPI: 1295698603
Provider Name (Legal Business Name): SPENCER KELLY WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/03/2025
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4852 W 118TH ST APT 1
HAWTHORNE CA
90250-2063
US

IV. Provider business mailing address

4852 W 118TH ST APT 1
HAWTHORNE CA
90250-2063
US

V. Phone/Fax

Practice location:
  • Phone: 310-663-0018
  • Fax:
Mailing address:
  • Phone: 310-663-0018
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number94005
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: