Individual
MR. KYLE DEVON WATTS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CTRS
Contact information
Practice address
79 MIDDLEVILLE RD, NORTHPORT, NY 11768-2200
(631) 261-4400
Mailing address
161 GRAND AVE, SHIRLEY, NY 11967-1926
(631) 605-4617
Taxonomy
Speciality
Code
Description
License number
State
225800000X
Recreation Therapist
Primary
—
—
Other
Enumeration date
04/12/2022
Last updated
04/12/2022
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