Provider Demographics
NPI:1841052198
Name:WATRAL, BECKY LYNN (OTR)
Entity type:Individual
Prefix:MRS
First Name:BECKY
Middle Name:LYNN
Last Name:WATRAL
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:BECKY
Other - Middle Name:LYNN
Other - Last Name:NADEAU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:4343 BUCKEY ST
Mailing Address - Street 2:
Mailing Address - City:EAST TROY
Mailing Address - State:WI
Mailing Address - Zip Code:53120-9635
Mailing Address - Country:US
Mailing Address - Phone:262-928-1921
Mailing Address - Fax:262-363-1918
Practice Address - Street 1:240 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:MUKWONAGO
Practice Address - State:WI
Practice Address - Zip Code:53149-8475
Practice Address - Country:US
Practice Address - Phone:262-928-1921
Practice Address - Fax:262-363-1918
Is Sole Proprietor?:No
Enumeration Date:2024-01-23
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2084-26225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation