Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | OT.003133 | OH |
N | 225XG0600X | Occupational Therapist - Gerontology | OT.003133 | OH |
N | 225XP0200X | Occupational Therapist - Pediatrics | OT.003133 | OH |
NPI | 1629480827 |
---|---|
Provider Name | Mrs. Juanita Davis |
First Address | Sheffield Lake, OH 44054-1819 |
Second Address | Sheffield Lake, OH 44054-1819 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2014 |
Last Update Date | 30/09/2014 |