Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 04309 | MD |
NPI | 1275290199 |
---|---|
Provider Name | Cathy Davis |
First Address | White Hall, MD 21161-8900 |
Second Address | White Hall, MD 21161-8900 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/11/2021 |
Last Update Date | 27/11/2021 |