Provider Demographics
NPI:1932823374
Name:WATTS, TAMEKA (COTA/L)
Entity type:Individual
Prefix:
First Name:TAMEKA
Middle Name:
Last Name:WATTS
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9664 ISLESWORTH WAY
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29485-9062
Mailing Address - Country:US
Mailing Address - Phone:770-572-6762
Mailing Address - Fax:
Practice Address - Street 1:10163 COUNTY LINE RD
Practice Address - Street 2:
Practice Address - City:CAMILLA
Practice Address - State:GA
Practice Address - Zip Code:31730-5061
Practice Address - Country:US
Practice Address - Phone:770-572-6762
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-29
Last Update Date:2024-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA436664224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant