Provider Demographics
NPI:1326373747
Name:DAVIS, ADELE (COTA)
Entity Type:Individual
Prefix:MRS
First Name:ADELE
Middle Name:
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 1:34 WILD DR
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:NY
Mailing Address - Zip Code:12549-2073
Mailing Address - Country:US
Mailing Address - Phone:845-778-2347
Mailing Address - Fax:845-778-2347
Practice Address - Street 1:175 WALGROVE AVE
Practice Address - Street 2:
Practice Address - City:DOBBS FERRY
Practice Address - State:NY
Practice Address - Zip Code:10522-3115
Practice Address - Country:US
Practice Address - Phone:914-693-1503
Practice Address - Fax:914-693-3188
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-04
Last Update Date:2009-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0073701224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant