Provider Demographics
NPI:1235592197
Name:DAVIS, GRAEME (COTA)
Entity Type:Individual
Prefix:
First Name:GRAEME
Middle Name:
Last Name:DAVIS
Suffix:
Gender:M
Credentials:COTA
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 1288
Mailing Address - Street 2:
Mailing Address - City:REHOBOTH BEACH
Mailing Address - State:DE
Mailing Address - Zip Code:19971-1288
Mailing Address - Country:US
Mailing Address - Phone:302-490-7858
Mailing Address - Fax:
Practice Address - Street 1:23816 BIRCH LN
Practice Address - Street 2:
Practice Address - City:LEWES
Practice Address - State:DE
Practice Address - Zip Code:19958-5341
Practice Address - Country:US
Practice Address - Phone:302-490-7858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-29
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEU2-1125163WR0400X
NJ46TA09023600163WR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0400XNursing Service ProvidersRegistered NurseRehabilitation