Provider Demographics
NPI:1669765582
Name:WATSON, EMILIE ANN (PTA)
Entity type:Individual
Prefix:MRS
First Name:EMILIE
Middle Name:ANN
Last Name:WATSON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MRS
Other - First Name:EMILIE
Other - Middle Name:ANN
Other - Last Name:WATSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PTA
Mailing Address - Street 1:6293 RIVER RUN PL
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32807-4273
Mailing Address - Country:US
Mailing Address - Phone:407-936-0314
Mailing Address - Fax:407-936-0316
Practice Address - Street 1:3577 LAKE EMMA RD
Practice Address - Street 2:ST 109
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-2056
Practice Address - Country:US
Practice Address - Phone:407-936-0314
Practice Address - Fax:407-936-0316
Is Sole Proprietor?:No
Enumeration Date:2011-05-25
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA22632174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist