Provider Demographics
NPI:1275009474
Name:DAVIS, JULIUS (COTA/L)
Entity Type:Individual
Prefix:
First Name:JULIUS
Middle Name:
Last Name:DAVIS
Suffix:
Gender:M
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 1:111 WELLMORE DR
Mailing Address - Street 2:
Mailing Address - City:TEGA CAY
Mailing Address - State:SC
Mailing Address - Zip Code:29708-0124
Mailing Address - Country:US
Mailing Address - Phone:803-835-7059
Mailing Address - Fax:
Practice Address - Street 1:111 WELLMORE DR
Practice Address - Street 2:
Practice Address - City:TEGA CAY
Practice Address - State:SC
Practice Address - Zip Code:29708-0124
Practice Address - Country:US
Practice Address - Phone:803-835-7059
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-16
Last Update Date:2018-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4870224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant