Basic Information
| Provider Information | |||||||||
| NPI: | 1346668860 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WATSON | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | ELLEN | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | OT | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | FOUST | ||||||||
| OtherFirstName: | MARY | ||||||||
| OtherMiddleName: | ELLEN | ||||||||
| OtherNamePrefix: | MISS | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | OT | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1040 WEDDING FORD RD | ||||||||
| Address2: | |||||||||
| City: | HEBER SPRINGS | ||||||||
| State: | AR | ||||||||
| PostalCode: | 725431914 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5013628137 | ||||||||
| FaxNumber: | 5013628960 | ||||||||
| Practice Location | |||||||||
| Address1: | 1040 WEDDING FORD RD | ||||||||
| Address2: | |||||||||
| City: | HEBER SPRINGS | ||||||||
| State: | AR | ||||||||
| PostalCode: | 725431914 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5013628137 | ||||||||
| FaxNumber: | 5013628960 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/01/2014 | ||||||||
| LastUpdateDate: | 04/16/2014 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | OTR608 | AR | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.