Provider Demographics
NPI:1548596265
Name:WILLIAMS, NANCI J (LMT)
Entity type:Individual
Prefix:
First Name:NANCI
Middle Name:J
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1675 SW MARLOW AVE
Mailing Address - Street 2:SUITE 307-D
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-5104
Mailing Address - Country:US
Mailing Address - Phone:503-939-9123
Mailing Address - Fax:503-530-8174
Practice Address - Street 1:1675 SW MARLOW AVE
Practice Address - Street 2:SUITE 307-D
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-5104
Practice Address - Country:US
Practice Address - Phone:503-939-9123
Practice Address - Fax:503-530-8174
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-30
Last Update Date:2014-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR14787225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist