Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | 46TR00205100 | NJ |
Y | 225XH1200X | Occupational Therapist - Hand | 46TR00205100 | NJ |
NPI | 1760580666 |
---|---|
Provider Name | Carolyn Watts |
First Address | Oceanport, NJ 07757-1707 |
Second Address | Oceanport, NJ 07757 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2006 |
Last Update Date | 18/05/2018 |