Provider Demographics
NPI:1447011077
Name:WATSON, KASEY (CNC, MS, CPT)
Entity type:Individual
Prefix:
First Name:KASEY
Middle Name:
Last Name:WATSON
Suffix:
Gender:F
Credentials:CNC, MS, CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 GOULD AVE
Mailing Address - Street 2:
Mailing Address - City:DEXTER
Mailing Address - State:ME
Mailing Address - Zip Code:04930-1108
Mailing Address - Country:US
Mailing Address - Phone:207-270-0264
Mailing Address - Fax:
Practice Address - Street 1:31 GOULD AVE
Practice Address - Street 2:
Practice Address - City:DEXTER
Practice Address - State:ME
Practice Address - Zip Code:04930-1108
Practice Address - Country:US
Practice Address - Phone:207-270-0264
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-22
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach