Individual
CAROL MARIE WATSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
3 CYPRESS PT PKWY STE 108C, PALM COAST, FL 32164-8408
(386) 366-3890
(386) 366-3890
Mailing address
61 ALDO CIR, BUNNELL, FL 32110-7998
(386) 366-3890
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
OTA8911
FL
224Z00000X
Occupational Therapy Assistant
Primary
OTA8911
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1497048094
—
FL
Enumeration date
05/16/2011
Last updated
11/20/2017
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