MEDICARE: COLEEN WATKINS

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	60189880	WA

General Provider Information

NPI Number	:	1760804439
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COLEEN WATKINS

Provider Business Mailing Address
First Line	:	21610 E BITTERROOT LN
Second Line	:
City	:	LIBERTY LAKE
State	:	WA
Zip	:	99019-5064
Country	:	US
Telephone Number	:	208-277-8458
Fax Number	:

Provider Business Practice Location Address
First Line	:	21610 E BITTERROOT LN
Second Line	:
City	:	LIBERTY LAKE
State	:	WA
Zip	:	99019-5064
Country	:	US
Telephone Number	:	208-277-8458
Fax Number	:

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

Provider Enumeration Date	:	01/14/2014
Last Update Date	:	01/14/2014

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Directions to “ COLEEN WATKINS ” Practice Location

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