Provider Demographics
NPI:1295773976
Name:WATKINS, LEONOR (PT)
Entity type:Individual
Prefix:
First Name:LEONOR
Middle Name:
Last Name:WATKINS
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 1:4202 SW LEE BLVD
Mailing Address - Street 2:BLDG B, SUITE 202
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-8300
Mailing Address - Country:US
Mailing Address - Phone:580-248-5668
Mailing Address - Fax:580-248-0785
Practice Address - Street 1:4202 SW LEE BLVD
Practice Address - Street 2:BLDG B, SUITE 202
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-8300
Practice Address - Country:US
Practice Address - Phone:580-248-5668
Practice Address - Fax:580-248-0785
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2643225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist