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General NPI Number Information
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NPI Number | 1245463769
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Entity Type | Individual
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Provider Name | CEDRIC D WATTS OTR/L
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Gender | Male
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Dates
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Enumeration Date | 09/01/2009
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Last Update Date | 01/04/2021
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Provider Practice Location Address
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Address Line | 7500 DOLLARWAY RD SUITE 301
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City | WHITE HALL
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State | AR
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Zip | 71602-3027
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Country | US
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Telephone | 870-329-9626
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Fax | 870-534-5912
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Provider Business Mailing Address
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Address Line | PO BOX 20969
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City | WHITE HALL
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State | AR
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Zip | 71612-0969
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Country | US
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Telephone | 870-247-2099
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Fax | 870-619-1687
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OTR 1983
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License Number State | AR
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