MEDICARE: DR. KARI S WATTS PH.D., BCBA-D

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	103TB0200X	Cognitive & Behavioral Psychologist	6688	OH
2	103TC2200X	Clinical Child & Adolescent Psychologist	6688	OH
3	103TM1800X	Intellectual & Developmental Disabilities Psychologist	6688	OH

General Provider Information

NPI Number	:	1821331851
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KARI S WATTS PH.D., BCBA-D

Provider Business Mailing Address
First Line	:	3780 RIDGE MILL DR
Second Line	:	SUITE 100
City	:	HILLIARD
State	:	OH
Zip	:	43026-7458
Country	:	US
Telephone Number	:	614-219-1510
Fax Number	:	614-219-1511

Provider Business Practice Location Address
First Line	:	3780 RIDGE MILL DR
Second Line	:	SUITE 100
City	:	HILLIARD
State	:	OH
Zip	:	43026-7458
Country	:	US
Telephone Number	:	614-219-1510
Fax Number	:	614-219-1511

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

Provider Enumeration Date	:	03/27/2013
Last Update Date	:	01/29/2015

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