Provider Demographics
NPI:1114129491
Name:WATSON, JACQUELINE (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:
Last Name:WATSON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4314
Mailing Address - Street 2:
Mailing Address - City:SPANAWAY
Mailing Address - State:WA
Mailing Address - Zip Code:98387
Mailing Address - Country:US
Mailing Address - Phone:425-395-6006
Mailing Address - Fax:360-878-8780
Practice Address - Street 1:1240 RUDDELL RD SE
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-5747
Practice Address - Country:US
Practice Address - Phone:425-395-6006
Practice Address - Fax:360-360-8274
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-31
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT60105178225X00000X
WAOT-60105178225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist