Provider Demographics
NPI:1376216978
Name:WATTS, EMILY K
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:K
Last Name:WATTS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4900 31ST ST S STE A
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22206-1663
Mailing Address - Country:US
Mailing Address - Phone:703-340-4325
Mailing Address - Fax:
Practice Address - Street 1:4900 31ST ST S STE A
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22206-1663
Practice Address - Country:US
Practice Address - Phone:703-340-4325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-29
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
0019014295225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0019014295OtherVIRGINIA BOARD OF NURSING