Provider Demographics
NPI:1316010168
Name:DAVISON, JEAN (OTL)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:
Last Name:DAVISON
Suffix:
Gender:F
Credentials:OTL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:976 REDSTONE RD
Mailing Address - Street 2:
Mailing Address - City:DACULA
Mailing Address - State:GA
Mailing Address - Zip Code:30019-7415
Mailing Address - Country:US
Mailing Address - Phone:770-995-2345
Mailing Address - Fax:678-392-4401
Practice Address - Street 1:976 REDSTONE RD
Practice Address - Street 2:
Practice Address - City:DACULA
Practice Address - State:GA
Practice Address - Zip Code:30019-7415
Practice Address - Country:US
Practice Address - Phone:770-995-2345
Practice Address - Fax:678-392-4401
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT000403225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics