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General NPI Number Information
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NPI Number | 1508059551
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Entity Type | Individual
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Provider Name | SUE ELLEN WILLIAMS LMT
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Gender | Female
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Dates
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Enumeration Date | 08/23/2007
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Last Update Date | 08/06/2009
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Provider Practice Location Address
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Address Line | 772 COUNTRY CLUB DR
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City | TITUSVILLE
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State | FL
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Zip | 32780-4955
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Country | US
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Telephone | 321-267-2233
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Fax |
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Provider Business Mailing Address
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Address Line | 5305 WATERMILL LN APT 204
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City | TITUSVILLE
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State | FL
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Zip | 32780-7808
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Country | US
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Telephone | 321-720-7765
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Fax | 321-567-4279
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MA46181
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License Number State | FL
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