Provider Demographics
NPI:1316569379
Name:DAVIS, SHEILA DENISE (COTA)
Entity Type:Individual
Prefix:
First Name:SHEILA
Middle Name:DENISE
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 1:303 W 80TH PL # 11484
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-5433
Mailing Address - Country:US
Mailing Address - Phone:219-613-2362
Mailing Address - Fax:
Practice Address - Street 1:2921 W 61ST PL APT 2G
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-2260
Practice Address - Country:US
Practice Address - Phone:219-613-2362
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-13
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL057004935224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant