Healthcare Provider Details

I. General information

NPI: 1912837519
Provider Name (Legal Business Name): CASSIDY J MCWATTERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2026
Last Update Date: 05/23/2026
Certification Date: 05/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 SPRING ST STE 4
PETOSKEY MI
49770-2881
US

IV. Provider business mailing address

18861 CLIPPERVIEW RD
CHARLEVOIX MI
49720-9711
US

V. Phone/Fax

Practice location:
  • Phone: 231-268-0007
  • Fax:
Mailing address:
  • Phone: 850-218-2682
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberM900001988217
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: