Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 224Z00000X | Occupational Therapy Assistant | 144A | SD |
N | 224Z00000X | Occupational Therapy Assistant | 5302 | AZ |
Y | 225XG0600X | Occupational Therapist - Gerontology | 5472 | AZ |
NPI | 1548505894 |
---|---|
Provider Name | Jaci Watson |
First Address | Keystone, SD 57751-0124 |
Second Address | Sedona, AZ 86351-7856 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/11/2012 |
Last Update Date | 15/05/2014 |