Provider Demographics
NPI:1770643496
Name:WATT, SHELLY ANN (CRTT)
Entity Type:Individual
Prefix:MS
First Name:SHELLY
Middle Name:ANN
Last Name:WATT
Suffix:
Gender:F
Credentials:CRTT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4961 PRETTY DOE LN
Mailing Address - Street 2:
Mailing Address - City:PASO ROBLES
Mailing Address - State:CA
Mailing Address - Zip Code:93446-4273
Mailing Address - Country:US
Mailing Address - Phone:805-237-1853
Mailing Address - Fax:805-237-1853
Practice Address - Street 1:4961 PRETTY DOE LN
Practice Address - Street 2:
Practice Address - City:PASO ROBLES
Practice Address - State:CA
Practice Address - Zip Code:93446-4273
Practice Address - Country:US
Practice Address - Phone:805-237-1853
Practice Address - Fax:805-237-1853
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00016880227800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Certified