Provider Demographics
NPI:1659660405
Name:HOTH-DAVIS, ANITA LOUISE (OTR)
Entity Type:Individual
Prefix:MS
First Name:ANITA
Middle Name:LOUISE
Last Name:HOTH-DAVIS
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MS
Other - First Name:ANITA
Other - Middle Name:
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTR
Mailing Address - Street 1:3306 E 105TH TER
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64137-1606
Mailing Address - Country:US
Mailing Address - Phone:303-507-7431
Mailing Address - Fax:913-663-1515
Practice Address - Street 1:3306 E 105TH TER
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64137-1606
Practice Address - Country:US
Practice Address - Phone:303-507-7431
Practice Address - Fax:913-663-1515
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-01
Last Update Date:2011-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010021565225X00000X
KS17-02702225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist