Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 2548 | SC |
NPI | 1003178591 |
---|---|
Provider Name | Christina L Davis |
First Address | Easton, PA 18040-7958 |
Second Address | Seneca, SC 29678-1122 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2012 |
Last Update Date | 12/06/2012 |