Provider Demographics
NPI:1811400773
Name:DAVIS, JANIS LAURSEN (OTR/L PHD)
Entity Type:Individual
Prefix:PROF
First Name:JANIS
Middle Name:LAURSEN
Last Name:DAVIS
Suffix:
Gender:F
Credentials:OTR/L PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1570 VIA CAPRI APT 5
Mailing Address - Street 2:
Mailing Address - City:LAGUNA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92651-1362
Mailing Address - Country:US
Mailing Address - Phone:913-449-7757
Mailing Address - Fax:
Practice Address - Street 1:27136 PASEO ESPADA
Practice Address - Street 2:
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675-2728
Practice Address - Country:US
Practice Address - Phone:949-429-3220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-14
Last Update Date:2017-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10768225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist