Provider Demographics
NPI:1346668860
Name:WATSON, MARY ELLEN (OT)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:ELLEN
Last Name:WATSON
Suffix:
Gender:F
Credentials:OT
Other - Prefix:MISS
Other - First Name:MARY
Other - Middle Name:ELLEN
Other - Last Name:FOUST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:1040 WEDDING FORD RD
Mailing Address - Street 2:
Mailing Address - City:HEBER SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:72543-1914
Mailing Address - Country:US
Mailing Address - Phone:501-362-8137
Mailing Address - Fax:501-362-8960
Practice Address - Street 1:1040 WEDDING FORD RD
Practice Address - Street 2:
Practice Address - City:HEBER SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:72543-1914
Practice Address - Country:US
Practice Address - Phone:501-362-8137
Practice Address - Fax:501-362-8960
Is Sole Proprietor?:No
Enumeration Date:2014-04-01
Last Update Date:2014-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR608225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist