Provider Demographics
NPI:1861587214
Name:WATSON, JOHN C (COTA)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:C
Last Name:WATSON
Suffix:
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:778 PERRY RD
Mailing Address - Street 2:
Mailing Address - City:TALLMADGE
Mailing Address - State:OH
Mailing Address - Zip Code:44278-3363
Mailing Address - Country:US
Mailing Address - Phone:330-945-9797
Mailing Address - Fax:
Practice Address - Street 1:5700 LOMBARDO CTR STE 205
Practice Address - Street 2:
Practice Address - City:SEVEN HILLS
Practice Address - State:OH
Practice Address - Zip Code:44131-6962
Practice Address - Country:US
Practice Address - Phone:330-945-9797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility