Provider Demographics
NPI:1336865799
Name:WATTS, LAKYN DANIELLE (PTA)
Entity Type:Individual
Prefix:
First Name:LAKYN
Middle Name:DANIELLE
Last Name:WATTS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:LAKYN
Other - Middle Name:DANIELLE
Other - Last Name:ROBERTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7506 HIGHWAY 26 W
Mailing Address - Street 2:
Mailing Address - City:OKOLONA
Mailing Address - State:AR
Mailing Address - Zip Code:71962-9779
Mailing Address - Country:US
Mailing Address - Phone:870-925-0243
Mailing Address - Fax:
Practice Address - Street 1:504 E 4TH ST N
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AR
Practice Address - Zip Code:71857-2254
Practice Address - Country:US
Practice Address - Phone:870-887-6674
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-18
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR4797225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant