Provider Demographics
NPI:1326822966
Name:DAVIS, KIARA ANTOINETTE (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:KIARA
Middle Name:ANTOINETTE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:456A COUNTY ROAD 601
Mailing Address - Street 2:
Mailing Address - City:GUNTOWN
Mailing Address - State:MS
Mailing Address - Zip Code:38849-3337
Mailing Address - Country:US
Mailing Address - Phone:662-255-2117
Mailing Address - Fax:
Practice Address - Street 1:1325 MCINGVALE RD
Practice Address - Street 2:
Practice Address - City:HERNANDO
Practice Address - State:MS
Practice Address - Zip Code:38632-1013
Practice Address - Country:US
Practice Address - Phone:662-429-2070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-23
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSOT4013225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist