Provider Demographics
NPI:1649810052
Name:WATKINS, REBECCA K (RPSGT, CCSH)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:K
Last Name:WATKINS
Suffix:
Gender:F
Credentials:RPSGT, CCSH
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:A
Other - Last Name:KELLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:110 E JIMMIE LEEDS RD
Mailing Address - Street 2:
Mailing Address - City:GALLOWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08205-9479
Mailing Address - Country:US
Mailing Address - Phone:609-748-7900
Mailing Address - Fax:609-748-7922
Practice Address - Street 1:110 E JIMMIE LEEDS RD
Practice Address - Street 2:
Practice Address - City:GALLOWAY
Practice Address - State:NJ
Practice Address - Zip Code:08205-9479
Practice Address - Country:US
Practice Address - Phone:609-748-7900
Practice Address - Fax:609-748-7922
Is Sole Proprietor?:No
Enumeration Date:2020-01-14
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ49FW00037600246Z00000X, 174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator
No246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other