Healthcare Provider Details

I. General information

NPI: 1922532332
Provider Name (Legal Business Name): LA TANYA WILLIAMS LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2017
Last Update Date: 04/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1275 E BALDWIN LN UNIT 308
PALATINE IL
60074-3080
US

IV. Provider business mailing address

541 NORTHGATE PKWY
WHEELING IL
60090-2663
US

V. Phone/Fax

Practice location:
  • Phone: 708-674-9060
  • Fax:
Mailing address:
  • Phone: 224-836-1160
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number227.018160
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: