Provider Demographics
NPI:1568137693
Name:WATTS, KACEY RENAE
Entity Type:Individual
Prefix:
First Name:KACEY
Middle Name:RENAE
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 1:402695 W 2340 DR
Mailing Address - Street 2:
Mailing Address - City:BARTLESVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74006-0541
Mailing Address - Country:US
Mailing Address - Phone:918-331-6003
Mailing Address - Fax:
Practice Address - Street 1:402695 W 2340 DR
Practice Address - Street 2:
Practice Address - City:BARTLESVILLE
Practice Address - State:OK
Practice Address - Zip Code:74006-0541
Practice Address - Country:US
Practice Address - Phone:918-331-6003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-11
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant