Provider Demographics
NPI:1346713088
Name:WATSON, KELSEY (OTR/L)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:WATSON
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 1:100B LYNCH RD
Mailing Address - Street 2:
Mailing Address - City:COWARD
Mailing Address - State:SC
Mailing Address - Zip Code:29530-5502
Mailing Address - Country:US
Mailing Address - Phone:423-291-0186
Mailing Address - Fax:
Practice Address - Street 1:401 NELSON BLVD
Practice Address - Street 2:
Practice Address - City:KINGSTREE
Practice Address - State:SC
Practice Address - Zip Code:29556-4024
Practice Address - Country:US
Practice Address - Phone:843-355-6116
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-05
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7473225X00000X
NC17235225X00000X
SC6951225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist