Healthcare Provider Details

I. General information

NPI: 1215732870
Provider Name (Legal Business Name): AMANDA RUTH WATSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/18/2025
Last Update Date: 02/18/2025
Certification Date: 02/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14043 ROAD 111
PAULDING OH
45879-9351
US

IV. Provider business mailing address

14043 ROAD 111
PAULDING OH
45879-9351
US

V. Phone/Fax

Practice location:
  • Phone: 419-770-5735
  • Fax:
Mailing address:
  • Phone: 419-770-5735
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: