Provider Demographics
NPI:1538744529
Name:WATSON, KELLIE (OTR)
Entity type:Individual
Prefix:
First Name:KELLIE
Middle Name:
Last Name:WATSON
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 808
Mailing Address - Street 2:
Mailing Address - City:VERADALE
Mailing Address - State:WA
Mailing Address - Zip Code:99037-0808
Mailing Address - Country:US
Mailing Address - Phone:509-363-3100
Mailing Address - Fax:509-363-0300
Practice Address - Street 1:510 E HOLLAND AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99218-1206
Practice Address - Country:US
Practice Address - Phone:509-363-3100
Practice Address - Fax:509-363-0300
Is Sole Proprietor?:No
Enumeration Date:2021-03-11
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61131989225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist