Provider Demographics
NPI:1275946097
Name:WATTS, STEPHEN (OTR/L)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:WATTS
Suffix:
Gender:M
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 1:42536 HAYES RD
Mailing Address - Street 2:SUITE 600
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-6766
Mailing Address - Country:US
Mailing Address - Phone:586-978-2359
Mailing Address - Fax:586-978-2372
Practice Address - Street 1:42536 HAYES RD
Practice Address - Street 2:SUITE 600
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-6766
Practice Address - Country:US
Practice Address - Phone:586-978-2359
Practice Address - Fax:586-978-2372
Is Sole Proprietor?:No
Enumeration Date:2014-06-10
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201008854225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist