MEDICARE: REBECCA WATKINS ICCE, ICD, CLC

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	374J00000X	Doula

General Provider Information

NPI Number	:	1649543935
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA WATKINS ICCE, ICD, CLC

Provider Business Mailing Address
First Line	:	2709 WILLIAM NEAL PKWY
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-7640
Country	:	US
Telephone Number	:	970-689-0256
Fax Number	:

Provider Business Practice Location Address
First Line	:	2709 WILLIAM NEAL PKWY
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-7640
Country	:	US
Telephone Number	:	970-689-0256
Fax Number	:

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

Provider Enumeration Date	:	02/16/2012
Last Update Date	:	02/16/2012

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