Provider Demographics
NPI:1609114099
Name:WATSON, ELIZABETH ANN (MED MOT OTR/L IBCLC)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ANN
Last Name:WATSON
Suffix:
Gender:F
Credentials:MED MOT OTR/L IBCLC
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:ANN
Other - Last Name:WATSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4385 W 60TH ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44144-2807
Mailing Address - Country:US
Mailing Address - Phone:216-659-1966
Mailing Address - Fax:
Practice Address - Street 1:4385 W 60TH ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44144-2807
Practice Address - Country:US
Practice Address - Phone:216-659-1966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-21
Last Update Date:2021-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174N00000X
OHOT011370225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No174N00000XOther Service ProvidersLactation Consultant, Non-RN
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHOT011370OtherNBCOT
11155310OtherIBLCE
L-35522OtherIBLCE