Provider Demographics
NPI:1144521808
Name:WILLIAMS, HOLLY JOY (LMT)
Entity type:Individual
Prefix:MRS
First Name:HOLLY
Middle Name:JOY
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 1:67 BARRINGTON CIR
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42003-8895
Mailing Address - Country:US
Mailing Address - Phone:270-534-4470
Mailing Address - Fax:
Practice Address - Street 1:115 KIANA CT
Practice Address - Street 2:C/O BAPTIST REHAB CENTER
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42001-6787
Practice Address - Country:US
Practice Address - Phone:270-534-1200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-11
Last Update Date:2010-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-1306247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO447930OtherABMP(ASSOCIATED BODYWORK & MASSAGE PROFESSIONALS
KYKY-1306OtherKY BOARD OF LICENSURE FOR MASSAGE THERAPISTS
UT4880660-4701OtherSTAT E OF UTAH DEPARTMENT OF COMMERCE