Provider Demographics
NPI:1780656405
Name:WATSON, ANGELA M (PT)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:M
Last Name:WATSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 JOHNSTON ST SE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35601-2516
Mailing Address - Country:US
Mailing Address - Phone:256-340-9706
Mailing Address - Fax:256-340-9624
Practice Address - Street 1:345 HEALTHWEST DR
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36303-2053
Practice Address - Country:US
Practice Address - Phone:334-836-4523
Practice Address - Fax:334-673-0599
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2017-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL0225225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL121682Medicaid
AL511-09122OtherBCBS OF ALABAMA
AL051530048WATMedicare ID - Type Unspecified
AL511-09122OtherBCBS OF ALABAMA
AL515-30048OtherBCBS - RCC REHAB
AL890014040Medicaid