Provider Demographics
NPI:1508421520
Name:DAVIS, WILLIAM DENTON (OTR/L)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:DENTON
Last Name:DAVIS
Suffix:
Gender:M
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:PO BOX 2061
Mailing Address - Street 2:
Mailing Address - City:KERNERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27285-2061
Mailing Address - Country:US
Mailing Address - Phone:336-310-5828
Mailing Address - Fax:888-511-1230
Practice Address - Street 1:1130 SNOW BRIDGE LN STE C
Practice Address - Street 2:
Practice Address - City:KERNERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27284-8411
Practice Address - Country:US
Practice Address - Phone:336-310-5828
Practice Address - Fax:888-511-1230
Is Sole Proprietor?:No
Enumeration Date:2019-05-06
Last Update Date:2019-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12517225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist