Provider Demographics
NPI:1700013604
Name:WATKINS, CAROLINE LILLIAN (OTR)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:LILLIAN
Last Name:WATKINS
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1325 CHURCHILL HUBBARD RD
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44505-1346
Mailing Address - Country:US
Mailing Address - Phone:330-759-5904
Mailing Address - Fax:330-759-8709
Practice Address - Street 1:10 WILMINGTON AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45420-1877
Practice Address - Country:US
Practice Address - Phone:937-258-2196
Practice Address - Fax:937-258-2196
Is Sole Proprietor?:No
Enumeration Date:2009-06-18
Last Update Date:2009-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT000463225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2577162Medicaid
OH2577162Medicaid