Provider Demographics
NPI:1760253520
Name:DAVIS, SEMAJ BELDON BOYD (COTA/L)
Entity Type:Individual
Prefix:MR
First Name:SEMAJ
Middle Name:BELDON BOYD
Last Name:DAVIS
Suffix:
Gender:M
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 1:28302 N MILL LN APT A
Mailing Address - Street 2:
Mailing Address - City:DEER PARK
Mailing Address - State:WA
Mailing Address - Zip Code:99006-5123
Mailing Address - Country:US
Mailing Address - Phone:951-662-3822
Mailing Address - Fax:
Practice Address - Street 1:222 E 5TH AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-1394
Practice Address - Country:US
Practice Address - Phone:509-344-5770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-10
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOC61338077224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant