Basic Information
| Provider Information | |||||||||
| NPI: | 1245630946 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DAVIS | ||||||||
| FirstName: | SUSAN | ||||||||
| MiddleName: | ELIZABETH | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | MOT/OTR/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10700 MONTGOMERY RD | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452423255 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5135053801 | ||||||||
| FaxNumber: | 5138311215 | ||||||||
| Practice Location | |||||||||
| Address1: | 1660 STERNBLOCK LN | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452373805 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5133210561 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/29/2014 | ||||||||
| LastUpdateDate: | 02/29/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225XP0200X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Pediatrics |
No ID Information.