Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner | 48723 MFTI | CA |
NPI | 1023146891 |
---|---|
Provider Name | Ms. Shannon Elia Williams |
First Address | Chino Hills, CA 91709-4576 |
Second Address | Pasadena, CA 91103-3333 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/03/2007 |
Last Update Date | 08/07/2007 |