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General NPI Number Information
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NPI Number | 1952199747
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Entity Type | Individual
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Provider Name | SYMPHONIE WATSON
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Gender | Female
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Dates
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Enumeration Date | 04/30/2025
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Last Update Date | 04/30/2025
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Provider Practice Location Address
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Address Line | 305 N 5TH ST
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City | WEST MEMPHIS
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State | AR
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Zip | 72301-3213
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Country | US
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Telephone | 870-400-0179
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Fax |
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Provider Business Mailing Address
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Address Line | 1225 GREAT RIVER RD APT 9
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City | MARION
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State | AR
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Zip | 72364
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Country | US
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Telephone | 870-636-6660
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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 | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | OT-A2117
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License Number State | AR
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