Healthcare Provider Details

I. General information

NPI: 1942701032
Provider Name (Legal Business Name): AMANDA JANE WATSON OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2018
Last Update Date: 02/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28511 ORCHARD LAKE RD
FARMINGTON HILLS MI
48334-2933
US

IV. Provider business mailing address

17187 N LAUREL PARK DR
LIVONIA MI
48152-3940
US

V. Phone/Fax

Practice location:
  • Phone: 800-968-6644
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number5201009659
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: