Healthcare Provider Details

I. General information

NPI: 1609028919
Provider Name (Legal Business Name): MICHAEL D WATSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2008
Last Update Date: 10/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N WESTSHORE BLVD SUITE 601
TAMPA FL
33609-1140
US

IV. Provider business mailing address

120 CAMILLE CT
OLDSMAR FL
34677-2226
US

V. Phone/Fax

Practice location:
  • Phone: 800-632-2191
  • Fax:
Mailing address:
  • Phone: 734-657-3971
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224ZF0002X
TaxonomyFeeding, Eating & Swallowing Occupational Therapy Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: