MEDICARE: CANDIS WATSON COTA/L

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	224Z00000X	Occupational Therapy Assistant	15433	FL

General Provider Information

NPI Number	:	1316482193
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CANDIS WATSON COTA/L

Provider Business Mailing Address
First Line	:	3331 NW 68TH CT
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33309-1234
Country	:	US
Telephone Number	:	864-906-5005
Fax Number	:

Provider Business Practice Location Address
First Line	:	3331 NW 68TH CT
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33309-1234
Country	:	US
Telephone Number	:	864-906-5005
Fax Number	:

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

Provider Enumeration Date	:	01/03/2017
Last Update Date	:	01/03/2017

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