Provider Demographics
NPI:1871959643
Name:WATERS, FLORENCE DENISE (COTA)
Entity type:Individual
Prefix:MRS
First Name:FLORENCE
Middle Name:DENISE
Last Name:WATERS
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:MRS
Other - First Name:DENISE
Other - Middle Name:GRANTLAND
Other - Last Name:WATERS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:COTA
Mailing Address - Street 1:1350 14TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35601-4364
Mailing Address - Country:US
Mailing Address - Phone:256-355-6911
Mailing Address - Fax:
Practice Address - Street 1:127 WHISPERWOOD DR
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:AL
Practice Address - Zip Code:35670-3862
Practice Address - Country:US
Practice Address - Phone:256-303-8753
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-11
Last Update Date:2016-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4154224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant