Provider Demographics
NPI:1467299438
Name:WATTS-BLOOD, SHONIKKA L (OTR/L)
Entity type:Individual
Prefix:
First Name:SHONIKKA
Middle Name:L
Last Name:WATTS-BLOOD
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:SHONIKKA
Other - Middle Name:L
Other - Last Name:BLOOD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4760 MORRISON RD
Mailing Address - Street 2:
Mailing Address - City:BRANCHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14418-9525
Mailing Address - Country:US
Mailing Address - Phone:315-759-3700
Mailing Address - Fax:
Practice Address - Street 1:220 STEUBEN ST
Practice Address - Street 2:
Practice Address - City:MONTOUR FALLS
Practice Address - State:NY
Practice Address - Zip Code:14865-9709
Practice Address - Country:US
Practice Address - Phone:607-535-7121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-09
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028848225XG0600X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontology