Provider Demographics
NPI:1114170388
Name:WATKINS, RANDALL SHAWN SR (OTR/L, ATC, NSCA-CPT)
Entity Type:Individual
Prefix:MR
First Name:RANDALL
Middle Name:SHAWN
Last Name:WATKINS
Suffix:SR
Gender:M
Credentials:OTR/L, ATC, NSCA-CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7923 SAINT MONICA DR
Mailing Address - Street 2:
Mailing Address - City:DUNDALK
Mailing Address - State:MD
Mailing Address - Zip Code:21222-3536
Mailing Address - Country:US
Mailing Address - Phone:443-850-1447
Mailing Address - Fax:
Practice Address - Street 1:29 GREENMEADOW DR
Practice Address - Street 2:
Practice Address - City:TIMONIUM
Practice Address - State:MD
Practice Address - Zip Code:21093-3256
Practice Address - Country:US
Practice Address - Phone:410-823-0870
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-31
Last Update Date:2010-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD06421225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation