Provider Demographics
NPI:1609028919
Name:WATSON, MICHAEL D
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:D
Last Name:WATSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 CAMILLE CT
Mailing Address - Street 2:
Mailing Address - City:OLDSMAR
Mailing Address - State:FL
Mailing Address - Zip Code:34677-2226
Mailing Address - Country:US
Mailing Address - Phone:734-657-3971
Mailing Address - Fax:
Practice Address - Street 1:600 N WESTSHORE BLVD
Practice Address - Street 2:SUITE 601
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-1140
Practice Address - Country:US
Practice Address - Phone:800-632-2191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-17
Last Update Date:2008-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224ZF0002XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantFeeding, Eating & Swallowing