Provider Demographics
NPI:1316418130
Name:WATTS, MELISSA R (SLP)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:R
Last Name:WATTS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 TIMBER TRACE DR
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33543-6502
Mailing Address - Country:US
Mailing Address - Phone:813-751-4032
Mailing Address - Fax:
Practice Address - Street 1:5301 WHEELER AVE
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72901-8339
Practice Address - Country:US
Practice Address - Phone:479-646-3454
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-06
Last Update Date:2018-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist