Provider Demographics
NPI:1144755281
Name:WATSON, ELTIE (CHT)
Entity Type:Individual
Prefix:
First Name:ELTIE
Middle Name:
Last Name:WATSON
Suffix:
Gender:F
Credentials:CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6025 CARMAN DR
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-4069
Mailing Address - Country:US
Mailing Address - Phone:503-544-9700
Mailing Address - Fax:
Practice Address - Street 1:15171 BANGY RD
Practice Address - Street 2:SUITE 121
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-3270
Practice Address - Country:US
Practice Address - Phone:503-544-9700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-26
Last Update Date:2017-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist