Individual
MS. AMY C WATT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
507 E ARMSTRONG AVENUE, PEORIA, IL 61603
(309) 686-1177
(309) 686-7722
Mailing address
404 WILSHIRE DR, WASHINGTON, IL 61571-1357
(309) 444-3971
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
370686250001
—
IL
Enumeration date
10/16/2008
Last updated
10/16/2008
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