Provider Demographics
NPI:1598335135
Name:WATT, RICHARD (OTR/L, ATP)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:
Last Name:WATT
Suffix:
Gender:M
Credentials:OTR/L, ATP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 GIARDINA RD
Mailing Address - Street 2:
Mailing Address - City:SAUGERTIES
Mailing Address - State:NY
Mailing Address - Zip Code:12477-3723
Mailing Address - Country:US
Mailing Address - Phone:518-751-8266
Mailing Address - Fax:518-776-1062
Practice Address - Street 1:20 GIARDINA RD
Practice Address - Street 2:
Practice Address - City:SAUGERTIES
Practice Address - State:NY
Practice Address - Zip Code:12477-3723
Practice Address - Country:US
Practice Address - Phone:518-751-8266
Practice Address - Fax:518-776-1062
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-27
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009285225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY009285OtherNEW YORK STATE OFFICE OF THE PROFESSIONS (LICENSE NUMBER)