Provider Demographics
NPI:1730727629
Name:WATTS, ERIKA (MSR, OTR/L)
Entity type:Individual
Prefix:
First Name:ERIKA
Middle Name:
Last Name:WATTS
Suffix:
Gender:F
Credentials:MSR, OTR/L
Other - Prefix:
Other - First Name:ERIKA
Other - Middle Name:
Other - Last Name:WILDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:408 KILBERRY CT
Mailing Address - Street 2:
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29170-3099
Mailing Address - Country:US
Mailing Address - Phone:803-359-6925
Mailing Address - Fax:
Practice Address - Street 1:100 TARRAR SPRINGS ROAD
Practice Address - Street 2:SPED
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072
Practice Address - Country:US
Practice Address - Phone:803-821-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-11
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist