Provider Demographics
NPI:1437413127
Name:DAVIS, JOANN (COTAL)
Entity Type:Individual
Prefix:MS
First Name:JOANN
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:COTAL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8701 PELLINGTON PL
Mailing Address - Street 2:APT 1
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23294-4830
Mailing Address - Country:US
Mailing Address - Phone:313-402-5468
Mailing Address - Fax:
Practice Address - Street 1:8701 PELLINGTON PL
Practice Address - Street 2:APT 1
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23294-4830
Practice Address - Country:US
Practice Address - Phone:313-402-5468
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-27
Last Update Date:2013-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5202007160224Z00000X
VA0131001008224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant