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STEPHANIE WATTS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
OTR

Contact information

Practice address
1050 SHILOH RD NW STE 303, KENNESAW, GA 30144-7197
(678) 779-0842
Mailing address
925 LAUREL CREST DR, WOODSTOCK, GA 30189-6897
(678) 779-0842

Taxonomy

Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
003025
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
003025
STATE LICENSE
GA
05
146018154A
GA
Enumeration date
02/03/2007
Last updated
09/18/2020
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