Provider Demographics
NPI:1285663880
Name:WATSON, MARY ALLEN (EDD, ATC LAT)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:ALLEN
Last Name:WATSON
Suffix:
Gender:F
Credentials:EDD, ATC LAT
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:29 LEAVIEW DR
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01085-1827
Mailing Address - Country:US
Mailing Address - Phone:413-572-5393
Mailing Address - Fax:
Practice Address - Street 1:577 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:MA
Practice Address - Zip Code:01085-2580
Practice Address - Country:US
Practice Address - Phone:413-572-5393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8052255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer