=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831903426
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SARA M WILLIAMS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/04/2025
-----------------------------------------------------
Last Update Date | 02/04/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5814 GRAHAM AVE STE 101
-----------------------------------------------------
City | SUMNER
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98390-2728
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-891-7093
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 20020 127TH STREET CT E
-----------------------------------------------------
City | BONNEY LAKE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98391-5421
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-423-0630
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | MA60590641
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------