Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | 9623 | CA |
Y | 225XP0200X | Occupational Therapist - Pediatrics | 9623 | CA |
NPI | 1023485414 |
---|---|
Provider Name | Heather Watson |
First Address | Willits, CA 95490-3303 |
Second Address | Willits, CA 95490-3303 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/09/2015 |
Last Update Date | 01/09/2015 |