Provider Information for 1831337294
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Mrs. TARA LANELL WATTS
Sex: Female
NPI: 1831337294
Last Updated: 2024-09-11
Certification Date: 2024-09-10
Certification Date: 2024-09-10
Details
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NPI | 1831337294 | ||||||||||||||||||||
Enumeration Date | 2009-01-23 | ||||||||||||||||||||
NPI Type | NPI-1 Individual | ||||||||||||||||||||
Sole Proprietor | NO | ||||||||||||||||||||
Status | Active | ||||||||||||||||||||
Mailing Address | 1345 W 7TH ST CHESTER, PA 19013-3315 United States Phone: 610-529-1302 | Fax: | ||||||||||||||||||||
Primary Practice Address | 1260 E WOODLAND AVE STE 212 SPRINGFIELD, PA 19064-3956 United States Phone: 610-566-7540 | Fax: | ||||||||||||||||||||
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