Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225XF0002X | Feeding, Eating & Swallowing | 11766 | CA |
N | 225XM0800X | Mental Health | 11766 | CA |
Y | 225XP0200X | Occupational Therapist - Pediatrics | 11766 | CA |
NPI | 1609110063 |
---|---|
Provider Name | Jennifer Lynn Davis |
First Address | San Jose, CA 95128-1313 |
Second Address | San Jose, CA 95128-1313 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/11/2012 |
Last Update Date | 24/03/2016 |