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General NPI Number Information
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NPI Number | 1245380971
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Entity Type | Individual
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Provider Name | AMBER MARISA WATFORD ATC, LAT
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Gender | Female
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Dates
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Enumeration Date | 01/12/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 10301 KANIS RD
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City | LITTLE ROCK
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State | AR
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Zip | 72205-6205
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Country | US
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Telephone | 501-604-6913
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Fax |
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Provider Business Mailing Address
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Address Line | 329 CHANDLER RD
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City | MALVERN
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State | AR
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Zip | 72104-7609
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AT 280
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License Number State | AR
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