Provider Demographics
NPI:1073840286
Name:DAVIS, JENNIFER LYNN (COTA/L)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:LYNN
Last Name:DAVIS
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 DALMAGRO ROAD
Mailing Address - Street 2:LOT 12
Mailing Address - City:BUTLER
Mailing Address - State:PA
Mailing Address - Zip Code:16002
Mailing Address - Country:US
Mailing Address - Phone:724-664-8603
Mailing Address - Fax:
Practice Address - Street 1:125 DALMAGRO RD
Practice Address - Street 2:LOT 12
Practice Address - City:BUTLER
Practice Address - State:PA
Practice Address - Zip Code:16002-9307
Practice Address - Country:US
Practice Address - Phone:724-664-8603
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-09
Last Update Date:2009-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP001775L224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant