Provider Demographics
NPI:1841704509
Name:WATSON, SHANE P (OTR, PTA)
Entity type:Individual
Prefix:
First Name:SHANE
Middle Name:P
Last Name:WATSON
Suffix:
Gender:M
Credentials:OTR, PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 S HIGH ST APT A
Mailing Address - Street 2:
Mailing Address - City:SWEETWATER
Mailing Address - State:TN
Mailing Address - Zip Code:37874-2434
Mailing Address - Country:US
Mailing Address - Phone:423-519-5381
Mailing Address - Fax:
Practice Address - Street 1:1234 FRYE ST
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:TN
Practice Address - Zip Code:37303-3052
Practice Address - Country:US
Practice Address - Phone:423-745-8181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-16
Last Update Date:2017-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist