Provider Demographics
NPI:1700691516
Name:WATSON, MARES MARTHA A (MT-25901)
Entity type:Individual
Prefix:MRS
First Name:MARES MARTHA
Middle Name:A
Last Name:WATSON
Suffix:
Gender:F
Credentials:MT-25901
Other - Prefix:MRS
Other - First Name:MARES MARTHA
Other - Middle Name:A
Other - Last Name:WATSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MT-25901
Mailing Address - Street 1:5623 E 22ND STREET
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711
Mailing Address - Country:US
Mailing Address - Phone:520-300-6610
Mailing Address - Fax:
Practice Address - Street 1:5623 E 22ND STREET
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711
Practice Address - Country:US
Practice Address - Phone:520-300-6610
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-10
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT-25901225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZMT-25901Medicaid