Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 06421 | MD |
NPI | 1114170388 |
---|---|
Provider Name | Mr. Randall Shawn Watkins SR. |
First Address | Dundalk, MD 21222-3536 |
Second Address | Timonium, MD 21093-3256 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2008 |
Last Update Date | 29/11/2010 |