Provider Demographics
NPI:1952488876
Name:WATTS, JEAN ANN (MOTR/L)
Entity Type:Individual
Prefix:MRS
First Name:JEAN
Middle Name:ANN
Last Name:WATTS
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:MS
Other - First Name:JEAN
Other - Middle Name:ANN
Other - Last Name:HERZFELDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MOTR/L
Mailing Address - Street 1:1504-13TH AVE
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265
Mailing Address - Country:US
Mailing Address - Phone:309-762-9552
Mailing Address - Fax:309-762-9610
Practice Address - Street 1:1504 13TH AVE
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-3113
Practice Address - Country:US
Practice Address - Phone:309-762-9552
Practice Address - Fax:309-762-9610
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2009-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056-006929225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist