Basic Information
| Provider Information | |||||||||
| NPI: | 1710184650 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DAVIS | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | LOU | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | IX | ||||||||
| Credential: | OT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2679 N FOREST RIDGE BLVD | ||||||||
| Address2: | |||||||||
| City: | HERNANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 344425123 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3527462371 | ||||||||
| FaxNumber: | 3527463729 | ||||||||
| Practice Location | |||||||||
| Address1: | 2679 N FOREST RIDGE BLVD | ||||||||
| Address2: | |||||||||
| City: | HERNANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 344425123 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3527462371 | ||||||||
| FaxNumber: | 3527463729 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/02/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 225X00000X | OT10044 | FL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.