Healthcare Provider Details

I. General information

NPI: 1588890917
Provider Name (Legal Business Name): ALISHA JUNE WATSON OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2009
Last Update Date: 05/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 CENTURY PARK S STE.128
BIRMINGHAM AL
35226-3943
US

IV. Provider business mailing address

700 CENTURY PARK S STE.128
BIRMINGHAM AL
35226-3943
US

V. Phone/Fax

Practice location:
  • Phone: 205-823-1215
  • Fax: 205-822-4999
Mailing address:
  • Phone: 205-823-1215
  • Fax: 205-822-4999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number1980
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: