Provider Demographics
NPI:1093976862
Name:WATSON, STEPHANIE FITZGERALD (RRT, AE-C)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:FITZGERALD
Last Name:WATSON
Suffix:
Gender:F
Credentials:RRT, AE-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6155 AUTUMN OAKS DR
Mailing Address - Street 2:
Mailing Address - City:OLIVE BRANCH
Mailing Address - State:MS
Mailing Address - Zip Code:38654-6611
Mailing Address - Country:US
Mailing Address - Phone:901-233-0403
Mailing Address - Fax:800-637-3197
Practice Address - Street 1:6155 AUTUMN OAKS DRIVE
Practice Address - Street 2:
Practice Address - City:OLIVE BRANCH
Practice Address - State:MS
Practice Address - Zip Code:38654-6611
Practice Address - Country:US
Practice Address - Phone:901-233-0403
Practice Address - Fax:800-637-3197
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-24
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRRT0000000967227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered