Provider Demographics
NPI:1275946063
Name:WATSON, TANYA EILEEN (ATC/L)
Entity Type:Individual
Prefix:MS
First Name:TANYA
Middle Name:EILEEN
Last Name:WATSON
Suffix:
Gender:F
Credentials:ATC/L
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Other - Credentials:
Mailing Address - Street 1:PO BOX 30001
Mailing Address - Street 2:MSC 3FAC
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88003-8001
Mailing Address - Country:US
Mailing Address - Phone:575-646-7182
Mailing Address - Fax:575-646-3435
Practice Address - Street 1:1815 WELLS ST
Practice Address - Street 2:RM 202
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88003-1304
Practice Address - Country:US
Practice Address - Phone:575-646-7182
Practice Address - Fax:575-646-3564
Is Sole Proprietor?:No
Enumeration Date:2014-06-09
Last Update Date:2015-01-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NM6112255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer