| Doctor Name: | KEVIN MARK WATSON |
| NPI Number: | 1992773972 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | ATC/L |
| License Number: | 36000424A |
| Business Practice Address: | 11130 Parkview Circle Dr Fort Wayne, IN - 468451735 |
| Business Phone Number: | 2609013261 |
| Business Fax Number: | |
| Mailing Address: | 1406 Villa Ct, NORTH MANCHESTER |
| State: | IN |
| Postal Code: | 469621344 |
| Phone Number: | 2609013261 |
| Fax Number: | |
| NPI Enumeration Date: | 03/08/2006 |
| NPI Last Update Date: | 03/14/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 174400000X |
| License Number: | 36000424A |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | IN |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Specialist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |