Provider Demographics
NPI:1679882674
Name:DAVIS, BRIAN M (MOT OTR/L)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:M
Last Name:DAVIS
Suffix:
Gender:M
Credentials:MOT OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 PINELAND DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NEW GLOUCESTER
Mailing Address - State:ME
Mailing Address - Zip Code:04260-5111
Mailing Address - Country:US
Mailing Address - Phone:207-688-2253
Mailing Address - Fax:207-688-4561
Practice Address - Street 1:41 PINELAND DR
Practice Address - Street 2:SUITE 200
Practice Address - City:NEW GLOUCESTER
Practice Address - State:ME
Practice Address - Zip Code:04260-5111
Practice Address - Country:US
Practice Address - Phone:207-688-2253
Practice Address - Fax:207-688-4561
Is Sole Proprietor?:No
Enumeration Date:2010-09-25
Last Update Date:2010-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
METO2428225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics