Provider Demographics
NPI:1346433414
Name:WATSON, BRENDA NANETTE (OT)
Entity Type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:NANETTE
Last Name:WATSON
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5325 N OAK ST APT C104
Mailing Address - Street 2:
Mailing Address - City:BETHEL HEIGHTS
Mailing Address - State:AR
Mailing Address - Zip Code:72764-8675
Mailing Address - Country:US
Mailing Address - Phone:479-751-7875
Mailing Address - Fax:
Practice Address - Street 1:5325 N OAK ST APT C104
Practice Address - Street 2:
Practice Address - City:BETHEL HEIGHTS
Practice Address - State:AR
Practice Address - Zip Code:72764-8675
Practice Address - Country:US
Practice Address - Phone:479-751-7875
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-22
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR1738225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist