Provider Demographics
NPI:1396777116
Name:WILLIAMS, JANE ANNE (AT, C)
Entity type:Individual
Prefix:MRS
First Name:JANE
Middle Name:ANNE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:AT, C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11202 JEFFERSON TRACE BLVD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40291-3695
Mailing Address - Country:US
Mailing Address - Phone:502-263-7889
Mailing Address - Fax:
Practice Address - Street 1:11202 JEFFERSON TRACE BLVD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40291-3695
Practice Address - Country:US
Practice Address - Phone:502-263-7889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYAT6122255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer