Provider Demographics
NPI:1346713088
Name:WATSON, KELSEY (COTA/L)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:WATSON
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 QUARRY RD
Mailing Address - Street 2:
Mailing Address - City:SHADY VALLEY
Mailing Address - State:TN
Mailing Address - Zip Code:37688-5100
Mailing Address - Country:US
Mailing Address - Phone:423-739-9318
Mailing Address - Fax:
Practice Address - Street 1:1633 HILLVIEW DR
Practice Address - Street 2:
Practice Address - City:ELIZABETHTON
Practice Address - State:TN
Practice Address - Zip Code:37643-4115
Practice Address - Country:US
Practice Address - Phone:423-543-2571
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-05
Last Update Date:2019-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNOTA0000002969224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant