Provider Demographics
NPI:1285405464
Name:WATKINS, CARLA LOUISE
Entity type:Individual
Prefix:
First Name:CARLA
Middle Name:LOUISE
Last Name:WATKINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2575 KUHIO AVE APT 702
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96815-3916
Mailing Address - Country:US
Mailing Address - Phone:630-488-9090
Mailing Address - Fax:
Practice Address - Street 1:2575 KUHIO AVE APT 702
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96815-3916
Practice Address - Country:US
Practice Address - Phone:630-488-9090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-16
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMAT-17702-0225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist