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General NPI Number Information
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NPI Number | 1306686308
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Entity Type | Individual
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Provider Name | MICHELLE WATTS OTR/L
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Gender | Female
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Dates
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Enumeration Date | 05/28/2024
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Last Update Date | 05/28/2024
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Provider Practice Location Address
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Address Line | 501 SE 12TH ST
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City | OAK GROVE
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State | MO
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Zip | 64075-9384
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Country | US
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Telephone | 816-690-4153
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Fax |
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Provider Business Mailing Address
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Address Line | 11273 BARB RD
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City | CORDER
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State | MO
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Zip | 64021-9105
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Country | US
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Telephone | 816-803-5451
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 2024018084
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License Number State | MO
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