Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | 00001557 | WA |
NPI | 1982848487 |
---|---|
Provider Name | Susan Marie Watters |
First Address | Bothell, WA 98011-6700 |
Second Address | Bothell, WA 98011-1900 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/04/2009 |
Last Update Date | 28/04/2009 |