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General NPI Number Information
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NPI Number | 1841704509
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Entity Type | Individual
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Provider Name | SHANE P WATSON OTR, PTA
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Gender | Male
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Dates
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Enumeration Date | 11/16/2017
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Last Update Date | 11/16/2017
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Provider Practice Location Address
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Address Line | 1234 FRYE ST
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City | ATHENS
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State | TN
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Zip | 37303-3052
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Country | US
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Telephone | 423-745-8181
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Fax |
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Provider Business Mailing Address
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Address Line | 207 S HIGH ST APT A
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City | SWEETWATER
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State | TN
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Zip | 37874-2434
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Country | US
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Telephone | 423-519-5381
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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 |
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License Number State |
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