Provider Demographics
NPI:1225464084
Name:DAVIDSON, DEBORA ANNE (PHD, ORT/L)
Entity Type:Individual
Prefix:MS
First Name:DEBORA
Middle Name:ANNE
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:PHD, ORT/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 878
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63006-0878
Mailing Address - Country:US
Mailing Address - Phone:636-399-8910
Mailing Address - Fax:
Practice Address - Street 1:16020 SWINGLEY RIDGE RD
Practice Address - Street 2:STE 130
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-6030
Practice Address - Country:US
Practice Address - Phone:636-399-4786
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-24
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO003358225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist