Provider Demographics
NPI:1275290199
Name:DAVIS, CATHY (OT/L, CPAM, CLT)
Entity Type:Individual
Prefix:
First Name:CATHY
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:OT/L, CPAM, CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5437 LONG CORNER RD
Mailing Address - Street 2:
Mailing Address - City:WHITE HALL
Mailing Address - State:MD
Mailing Address - Zip Code:21161-8900
Mailing Address - Country:US
Mailing Address - Phone:443-613-3434
Mailing Address - Fax:
Practice Address - Street 1:5437 LONG CORNER RD
Practice Address - Street 2:
Practice Address - City:WHITE HALL
Practice Address - State:MD
Practice Address - Zip Code:21161-8900
Practice Address - Country:US
Practice Address - Phone:443-613-3434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-27
Last Update Date:2021-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04309225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation