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NPI Code Detail

MEDICARE: MRS. MARY ELLEN WATSON OT

MEDICARE: MRS. MARY ELLEN WATSON OT
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
1225X00000XOccupational TherapistOTR608AR

General Provider Information

NPI Number : 1346668860
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MARY ELLEN WATSON OT
Provider Business Mailing Address
First Line : 1040 WEDDING FORD RD
Second Line :
City : HEBER SPRINGS
State : AR
Zip : 72543-1914
Country : US
Telephone Number : 501-362-8137
Fax Number : 501-362-8960
Provider Business Practice Location Address
First Line : 1040 WEDDING FORD RD
Second Line :
City : HEBER SPRINGS
State : AR
Zip : 72543-1914
Country : US
Telephone Number : 501-362-8137
Fax Number : 501-362-8960
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/01/2014
Last Update Date : 04/16/2014

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