Healthcare Provider Details

I. General information

NPI: 1316886864
Provider Name (Legal Business Name): MITCHELL WATTS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2026
Last Update Date: 03/27/2026
Certification Date: 03/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 HIGHLANDS DR
LITITZ PA
17543-7694
US

IV. Provider business mailing address

150 RED MULBERRY WAY APT 1
CHARLESTON WV
25306-6318
US

V. Phone/Fax

Practice location:
  • Phone: 717-625-5668
  • Fax:
Mailing address:
  • Phone: 570-441-2729
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: