Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | OT2353 | CA |
NPI | 1003031444 |
---|---|
Provider Name | Mrs. Lori Lynn Davis |
First Address | Colton, CA 92324-3905 |
Second Address | Colton, CA 92324-3905 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2007 |
Last Update Date | 08/07/2007 |