Healthcare Provider Details

I. General information

NPI: 1386912640
Provider Name (Legal Business Name): PAMELA A WILLIAMS LMT, LE, RM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2011
Last Update Date: 05/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 W MONROE ST
DUNDEE MI
48131-1240
US

IV. Provider business mailing address

238 SIDNEY ST
DUNDEE MI
48131-1267
US

V. Phone/Fax

Practice location:
  • Phone: 734-529-2323
  • Fax:
Mailing address:
  • Phone: 734-529-5695
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number7501001085
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: