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NPI Code Detail

MEDICARE: RAQUILLA WILLIAMS

MEDICARE:   RAQUILLA  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
1222Q00000XDevelopmental Therapist
2222Q00000XDevelopmental TherapistIL

General Provider Information

NPI Number : 1710440003
Entity Type Code : Individual
Provider Name (Legal Business Name) : RAQUILLA WILLIAMS
Provider Business Mailing Address
First Line : 14500 S RICHMOND AVE APT 3
Second Line :
City : POSEN
State : IL
Zip : 60469-1133
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 14500 S RICHMOND AVE APT 3
Second Line :
City : POSEN
State : IL
Zip : 60469-1133
Country : US
Telephone Number : 773-681-6346
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/12/2019
Last Update Date : 04/12/2019

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Directions to “ RAQUILLA WILLIAMS ” Practice Location

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