Provider Demographics
NPI:1750367819
Name:WATT, CHRISTINE ANNETTE (OTR/L)
Entity type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:ANNETTE
Last Name:WATT
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 1:42 BOBETTE LN
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:IL
Mailing Address - Zip Code:62901-5866
Mailing Address - Country:US
Mailing Address - Phone:618-549-0405
Mailing Address - Fax:
Practice Address - Street 1:6 E SHAWNEE DR
Practice Address - Street 2:
Practice Address - City:MURPHYSBORO
Practice Address - State:IL
Practice Address - Zip Code:62966-7048
Practice Address - Country:US
Practice Address - Phone:618-684-8018
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist