Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 0119008933 | VA |
NPI | 1063095768 |
---|---|
Provider Name | Miss Mary Page Watts |
First Address | Roanoke, VA 24014-3342 |
Second Address | Roanoke, VA 24016-5204 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/04/2021 |
Last Update Date | 30/04/2021 |