Provider Demographics
NPI:1417262403
Name:WATKINS, MAUREEN K (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:MAUREEN
Middle Name:K
Last Name:WATKINS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:DR
Other - First Name:MAUREEN
Other - Middle Name:K
Other - Last Name:SHILALE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT DPT
Mailing Address - Street 1:102 SHORE DR
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605-3154
Mailing Address - Country:US
Mailing Address - Phone:508-854-4140
Mailing Address - Fax:
Practice Address - Street 1:102 SHORE DR
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-3154
Practice Address - Country:US
Practice Address - Phone:508-854-4140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-13
Last Update Date:2011-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10480225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist