Provider Demographics
NPI:1487784062
Name:WATSON, ORLIN R (ATC)
Entity type:Individual
Prefix:
First Name:ORLIN
Middle Name:R
Last Name:WATSON
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 603A
Mailing Address - Street 2:
Mailing Address - City:KENNEBUNKPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04046-1603
Mailing Address - Country:US
Mailing Address - Phone:207-251-1427
Mailing Address - Fax:
Practice Address - Street 1:52 SANFORD HIGH BLVD
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:ME
Practice Address - Zip Code:04073-3427
Practice Address - Country:US
Practice Address - Phone:207-651-9571
Practice Address - Fax:207-324-8080
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEAT2612255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer