Provider Demographics
NPI:1780952085
Name:WATSON, BRITTANY LEIGH (OTA/L)
Entity type:Individual
Prefix:
First Name:BRITTANY
Middle Name:LEIGH
Last Name:WATSON
Suffix:
Gender:F
Credentials:OTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:691 GARLAND GIN RD
Mailing Address - Street 2:
Mailing Address - City:DOWNSVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71234-5063
Mailing Address - Country:US
Mailing Address - Phone:318-517-8893
Mailing Address - Fax:
Practice Address - Street 1:1751 N 15TH ST
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79603-4430
Practice Address - Country:US
Practice Address - Phone:318-517-8893
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-01
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX211448224Z00000X
LA200266224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant