Provider Demographics
NPI:1376282301
Name:WATSON, KADIJAH TIANETTA
Entity Type:Individual
Prefix:
First Name:KADIJAH
Middle Name:TIANETTA
Last Name:WATSON
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 1:1257 DIETZ AVE
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44301-2216
Mailing Address - Country:US
Mailing Address - Phone:330-618-8006
Mailing Address - Fax:
Practice Address - Street 1:992 HAMMEL ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44306-2234
Practice Address - Country:US
Practice Address - Phone:330-618-8006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-27
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care