Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | OT00002861 | WA |
NPI | 1427286210 |
---|---|
Provider Name | Jessica L Davis |
First Address | Duvall, WA 98019-7811 |
Second Address | Redmond, WA 98052-4583 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2009 |
Last Update Date | 30/06/2009 |