Provider Demographics
NPI:1013544105
Name:WATTS, KRISTINE ELIZABETH (LAT, ATC)
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:ELIZABETH
Last Name:WATTS
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 FOX PARK DR APT 3
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03264-1472
Mailing Address - Country:US
Mailing Address - Phone:262-910-1839
Mailing Address - Fax:
Practice Address - Street 1:17 HIGH ST
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03264-1595
Practice Address - Country:US
Practice Address - Phone:262-910-1839
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-26
Last Update Date:2020-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH13142255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer