Provider Demographics
NPI:1801106950
Name:WATTS, CLARA LOIUSE (MT)
Entity type:Individual
Prefix:MRS
First Name:CLARA
Middle Name:LOIUSE
Last Name:WATTS
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 MAIN ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:NORTH WILKESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28659-4254
Mailing Address - Country:US
Mailing Address - Phone:336-838-7037
Mailing Address - Fax:
Practice Address - Street 1:915 MAIN ST.
Practice Address - Street 2:SUITE 201
Practice Address - City:NORTH WILKESBORO
Practice Address - State:NC
Practice Address - Zip Code:28659
Practice Address - Country:US
Practice Address - Phone:336-838-7037
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-07
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC00449225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist