Healthcare Provider Details

I. General information

NPI: 1538092903
Provider Name (Legal Business Name): MICHELLE WATKINS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

11825 STATE ROUTE 160
VINTON OH
45686-9009
US

IV. Provider business mailing address

2628 WHITE OAK RD
BIDWELL OH
45614-9681
US

V. Phone/Fax

Practice location:
  • Phone: 740-245-3051
  • Fax: 740-245-3052
Mailing address:
  • Phone: 740-245-3051
  • Fax: 740-245-3052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: