Provider Demographics
NPI:1629358114
Name:DAVIDSON, MONIQUE RENEE (COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:MONIQUE
Middle Name:RENEE
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1117 TOURELLO LN
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89144-1206
Mailing Address - Country:US
Mailing Address - Phone:702-242-5986
Mailing Address - Fax:
Practice Address - Street 1:1117 TOURELLO LN
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89144-1206
Practice Address - Country:US
Practice Address - Phone:702-242-5986
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-28
Last Update Date:2011-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV10-7037224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant