MEDICARE: CHANTEL WILLIAMS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	MT21003614	IN

General Provider Information

NPI Number	:	1194166181
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHANTEL WILLIAMS

Provider Business Mailing Address
First Line	:	2212 LYNN AVE
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46805-3741
Country	:	US
Telephone Number	:	260-755-8855
Fax Number	:

Provider Business Practice Location Address
First Line	:	2212 LYNN AVE
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46805-3741
Country	:	US
Telephone Number	:	260-755-8855
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/08/2013
Last Update Date	:	07/08/2013

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Directions to “ CHANTEL WILLIAMS ” Practice Location

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