Provider Demographics
NPI:1932834066
Name:WATKINS, JOELLE RENEE (CTRS)
Entity Type:Individual
Prefix:
First Name:JOELLE
Middle Name:RENEE
Last Name:WATKINS
Suffix:
Gender:F
Credentials:CTRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 608949
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32860-8949
Mailing Address - Country:US
Mailing Address - Phone:352-877-5764
Mailing Address - Fax:
Practice Address - Street 1:58 PINE TRACE CRSE
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34472-9626
Practice Address - Country:US
Practice Address - Phone:352-877-5764
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
67272225800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation TherapistGroup - Single Specialty