Provider Demographics
NPI:1225342330
Name:DAVIS, TINA M (OT)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:M
Last Name:DAVIS
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4162 ROANOKE DR
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:OH
Mailing Address - Zip Code:44212-5318
Mailing Address - Country:US
Mailing Address - Phone:330-220-2644
Mailing Address - Fax:
Practice Address - Street 1:839 PEARL RD
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:OH
Practice Address - Zip Code:44212-2559
Practice Address - Country:US
Practice Address - Phone:330-225-4182
Practice Address - Fax:866-851-8273
Is Sole Proprietor?:No
Enumeration Date:2010-07-30
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2395225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist