Provider Demographics
NPI:1740773969
Name:DAVENPORT, DAVID (OT, CHT)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:DAVENPORT
Suffix:
Gender:M
Credentials:OT, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 N PLANT AVE
Mailing Address - Street 2:
Mailing Address - City:PLANT CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33563-7248
Mailing Address - Country:US
Mailing Address - Phone:813-478-9665
Mailing Address - Fax:
Practice Address - Street 1:414 N PLANT AVE
Practice Address - Street 2:
Practice Address - City:PLANT CITY
Practice Address - State:FL
Practice Address - Zip Code:33563-7248
Practice Address - Country:US
Practice Address - Phone:813-478-9665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-12
Last Update Date:2018-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT5386225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand