Healthcare Provider Details

I. General information

NPI: 1831982065
Provider Name (Legal Business Name): NITAJAH WATSON RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2025
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

92-424 KAIAULU ST
KAPOLEI HI
96707-1005
US

IV. Provider business mailing address

557 W LAKE AVE NW APT 226
ATLANTA GA
30318-6516
US

V. Phone/Fax

Practice location:
  • Phone: 312-925-1824
  • Fax:
Mailing address:
  • Phone: 312-925-1824
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-437648
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: