Provider Demographics
NPI:1982848487
Name:WATTERS, SUSAN MARIE (OTR/L)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:MARIE
Last Name:WATTERS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10512 NE 170TH ST
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98011-6700
Mailing Address - Country:US
Mailing Address - Phone:425-485-8325
Mailing Address - Fax:
Practice Address - Street 1:18107 BOTHELL WAY NE
Practice Address - Street 2:SUITE # 106
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98011-1900
Practice Address - Country:US
Practice Address - Phone:425-487-3142
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-28
Last Update Date:2009-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00001557225XN1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XN1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistNeurorehabilitation