MEDICARE: MS. CARRIE MICHELLE WATKINS MS CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	6876	MA

General Provider Information

NPI Number	:	1184831034
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CARRIE MICHELLE WATKINS MS CCC-SLP

Provider Business Mailing Address
First Line	:	146 WASHINGTON AVE
Second Line	:
City	:	WEST NEWTON
State	:	MA
Zip	:	02465-1026
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	37 MAGAZINE ST
Second Line	:
City	:	BEDFORD
State	:	NH
Zip	:	03110-4810
Country	:	US
Telephone Number	:	603-472-9732
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/17/2007
Last Update Date	:	07/08/2007

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