Provider Demographics
NPI:1861886483
Name:WATTS, RICHARD ROBERT (ATC)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:ROBERT
Last Name:WATTS
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2764
Mailing Address - Street 2:
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96745-2764
Mailing Address - Country:US
Mailing Address - Phone:808-960-8763
Mailing Address - Fax:
Practice Address - Street 1:74-5000 PUOHULIHULI ST
Practice Address - Street 2:
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-3318
Practice Address - Country:US
Practice Address - Phone:808-313-3787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-20
Last Update Date:2015-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAT-1862255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer