=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700745973
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ERIC S WATKINS OTR/L
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/21/2026
-----------------------------------------------------
Last Update Date | 01/21/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 200 W GOLF RD
-----------------------------------------------------
City | LIBERTYVILLE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60048-3234
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-680-1092
-----------------------------------------------------
Fax | 847-573-4316
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7613 22ND AVE
-----------------------------------------------------
City | KENOSHA
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53143-5717
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 262-748-3797
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225XP0019X
-----------------------------------------------------
Taxonomy Name | Physical Rehabilitation Occupational Therapist
-----------------------------------------------------
License Number | 056.016792
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------