Provider Demographics
NPI:1366299281
Name:WATTS, JACOB J
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:J
Last Name:WATTS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1038 WATKINS GLEN CT
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43040-8360
Mailing Address - Country:US
Mailing Address - Phone:419-203-6095
Mailing Address - Fax:
Practice Address - Street 1:1038 WATKINS GLEN CT
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43040-8360
Practice Address - Country:US
Practice Address - Phone:419-203-6095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-30
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker