Provider Demographics
NPI:1093844466
Name:WATTS, MARY LYNN (ATC, MLT)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:LYNN
Last Name:WATTS
Suffix:
Gender:F
Credentials:ATC, MLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4075 9TH ST
Mailing Address - Street 2:#101
Mailing Address - City:FT WAINWRIGHT
Mailing Address - State:AK
Mailing Address - Zip Code:99703-7495
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4075 9TH ST
Practice Address - Street 2:#101
Practice Address - City:FT WAINWRIGHT
Practice Address - State:AK
Practice Address - Zip Code:99703-7495
Practice Address - Country:US
Practice Address - Phone:907-356-6878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Not Answered246R00000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Pathology