Provider Demographics
NPI:1639337264
Name:WATSON-CROSBY, RENEE SAMONE (OTR)
Entity Type:Individual
Prefix:MS
First Name:RENEE
Middle Name:SAMONE
Last Name:WATSON-CROSBY
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:RENEE
Other - Middle Name:
Other - Last Name:WATSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OTR
Mailing Address - Street 1:36705 SPANISH OAK DR
Mailing Address - Street 2:
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48186-3403
Mailing Address - Country:US
Mailing Address - Phone:313-740-5019
Mailing Address - Fax:
Practice Address - Street 1:36705 SPANISH OAK DR
Practice Address - Street 2:
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48186-3403
Practice Address - Country:US
Practice Address - Phone:313-740-5019
Practice Address - Fax:313-740-5019
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-30
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225X00000X
MI5201007293225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist