Provider Demographics
NPI:1306686308
Name:WATTS, MICHELLE (OTR/L)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:WATTS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11273 BARB RD
Mailing Address - Street 2:
Mailing Address - City:CORDER
Mailing Address - State:MO
Mailing Address - Zip Code:64021-9105
Mailing Address - Country:US
Mailing Address - Phone:816-803-5451
Mailing Address - Fax:
Practice Address - Street 1:501 SE 12TH ST
Practice Address - Street 2:
Practice Address - City:OAK GROVE
Practice Address - State:MO
Practice Address - Zip Code:64075-9384
Practice Address - Country:US
Practice Address - Phone:816-690-4153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-28
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2024018084225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist