Provider Demographics
NPI:1225184401
Name:WATSON, MELISSA KAY (CSFA)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:KAY
Last Name:WATSON
Suffix:
Gender:F
Credentials:CSFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4906 MYRTLE BEACH DR
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33872-1720
Mailing Address - Country:US
Mailing Address - Phone:772-349-5495
Mailing Address - Fax:772-925-8333
Practice Address - Street 1:320 E CARPENTER ST STE 1A
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62702-5165
Practice Address - Country:US
Practice Address - Phone:217-523-0808
Practice Address - Fax:217-523-9859
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-28
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL320070847OtherTAX ID NUMBER