Healthcare Provider Details

I. General information

NPI: 1588094015
Provider Name (Legal Business Name): MRS. TAMARA LYNN WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2013
Last Update Date: 11/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 N 7TH ST
MARIETTA OH
45750-2024
US

IV. Provider business mailing address

400 N 7TH ST
MARIETTA OH
45750-2024
US

V. Phone/Fax

Practice location:
  • Phone: 740-373-3597
  • Fax: 740-376-0004
Mailing address:
  • Phone: 740-373-3597
  • Fax: 740-376-0004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA 05691
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: