Provider Demographics
NPI:1457677718
Name:WATT, ANNE MARIE (OTR/L)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:MARIE
Last Name:WATT
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1514 RAGLEY HALL RD NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30319-2520
Mailing Address - Country:US
Mailing Address - Phone:404-217-7643
Mailing Address - Fax:
Practice Address - Street 1:1514 RAGLEY HALL RD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30319-2520
Practice Address - Country:US
Practice Address - Phone:404-217-7643
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-12
Last Update Date:2010-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT000898174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist