Provider Demographics
NPI:1952088833
Name:WATSON, CARLY ALIVIA
Entity Type:Individual
Prefix:
First Name:CARLY
Middle Name:ALIVIA
Last Name:WATSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5529 S WINDERMERE ST APT 5
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80120-1250
Mailing Address - Country:US
Mailing Address - Phone:949-378-4426
Mailing Address - Fax:
Practice Address - Street 1:5529 S WINDERMERE ST
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80120-1275
Practice Address - Country:US
Practice Address - Phone:949-378-4426
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-03
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0024651225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist