Provider Demographics
NPI:1295386126
Name:DAVIS, MALERIE S (COTA)
Entity Type:Individual
Prefix:
First Name:MALERIE
Middle Name:S
Last Name:DAVIS
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 GREENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-5325
Mailing Address - Country:US
Mailing Address - Phone:386-268-3313
Mailing Address - Fax:
Practice Address - Street 1:1001 MOUNTAIN ST
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89703-3848
Practice Address - Country:US
Practice Address - Phone:775-443-4800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-23
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL17428224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant