MEDICARE: MRS. ELISABETH PEZZANO WATTERSON OTR/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	225X00000X	Occupational Therapist	OT003381	GA

General Provider Information

NPI Number	:	1689826810
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ELISABETH PEZZANO WATTERSON OTR/L

Provider Business Mailing Address
First Line	:	2310 CROSS SPRINGS DR
Second Line	:
City	:	CUMMING
State	:	GA
Zip	:	30041-7826
Country	:	US
Telephone Number	:	770-710-4509
Fax Number	:

Provider Business Practice Location Address
First Line	:	2310 CROSS SPRINGS DR
Second Line	:
City	:	CUMMING
State	:	GA
Zip	:	30041-7826
Country	:	US
Telephone Number	:	770-710-4509
Fax Number	:

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

Provider Enumeration Date	:	10/21/2008
Last Update Date	:	08/26/2016

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