Provider Demographics
NPI:1871794651
Name:WATTS, PAULETTE COOPER (RN, LMT)
Entity type:Individual
Prefix:MRS
First Name:PAULETTE
Middle Name:COOPER
Last Name:WATTS
Suffix:
Gender:F
Credentials:RN, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 ELMWOOD ST
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70448-6318
Mailing Address - Country:US
Mailing Address - Phone:985-674-2604
Mailing Address - Fax:
Practice Address - Street 1:207 ELMWOOD ST
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70448-6318
Practice Address - Country:US
Practice Address - Phone:985-674-2604
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2351172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist