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General NPI Number Information
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NPI Number | 1861886483
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Entity Type | Individual
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Provider Name | RICHARD ROBERT WATTS ATC
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Gender | Male
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Dates
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Enumeration Date | 03/20/2015
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Last Update Date | 03/20/2015
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Provider Practice Location Address
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Address Line | 74-5000 PUOHULIHULI ST
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City | KAILUA KONA
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State | HI
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Zip | 96740-3318
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Country | US
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Telephone | 808-313-3787
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2764
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City | KAILUA KONA
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State | HI
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Zip | 96745-2764
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Country | US
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Telephone | 808-960-8763
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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-186
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License Number State | HI
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