Provider Demographics
NPI:1750691762
Name:WILLIAMS, SAMANTHA MARIE (DT)
Entity type:Individual
Prefix:MS
First Name:SAMANTHA
Middle Name:MARIE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:DT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2988 EVERETT LN
Mailing Address - Street 2:
Mailing Address - City:BYRON
Mailing Address - State:IL
Mailing Address - Zip Code:61010-9711
Mailing Address - Country:US
Mailing Address - Phone:815-218-0357
Mailing Address - Fax:
Practice Address - Street 1:2988 EVERETT LN
Practice Address - Street 2:
Practice Address - City:BYRON
Practice Address - State:IL
Practice Address - Zip Code:61010-9711
Practice Address - Country:US
Practice Address - Phone:815-218-0357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-13
Last Update Date:2010-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist