Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | OT004563 | |
N | 225XH1200X | Occupational Therapist - Hand | OT004563 | GA |
N | 225XN1300X | Occupational Therapist - Neurorehabilitation | OT004563 | GA |
N | 225XP0200X | Occupational Therapist - Pediatrics | OT004563 | GA |
NPI | 1043494487 |
---|---|
Provider Name | Mrs. Malaika Davis |
First Address | Griffin, GA 30224-0047 |
Second Address | Griffin, GA 30224-4214 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/12/2007 |
Last Update Date | 20/12/2007 |