Provider Demographics
NPI:1144040353
Name:WATTS, ALYSHA GWEN
Entity type:Individual
Prefix:
First Name:ALYSHA
Middle Name:GWEN
Last Name:WATTS
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 1:108 YUKON DR
Mailing Address - Street 2:
Mailing Address - City:COMMERCIAL POINT
Mailing Address - State:OH
Mailing Address - Zip Code:43116-9749
Mailing Address - Country:US
Mailing Address - Phone:740-641-4027
Mailing Address - Fax:
Practice Address - Street 1:1679 LAUREL AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43223-2819
Practice Address - Country:US
Practice Address - Phone:614-279-2515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-14
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant