Provider Demographics
NPI:1205387305
Name:DAVIS, EMILY E (OTR/L)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:E
Last Name:DAVIS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:E
Other - Last Name:EVANS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:504 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28358-4620
Mailing Address - Country:US
Mailing Address - Phone:601-580-1026
Mailing Address - Fax:
Practice Address - Street 1:210 LIBERTY HILL RD
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-2442
Practice Address - Country:US
Practice Address - Phone:910-272-9056
Practice Address - Fax:910-272-9057
Is Sole Proprietor?:No
Enumeration Date:2016-10-24
Last Update Date:2017-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10668225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist