Provider Demographics
NPI:1871844746
Name:DAVIDSON, TRICIA SHEREEN (COTA/L)
Entity Type:Individual
Prefix:
First Name:TRICIA
Middle Name:SHEREEN
Last Name:DAVIDSON
Suffix:
Gender:F
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 1:6311 NW HERMES CT
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986-3881
Mailing Address - Country:US
Mailing Address - Phone:954-296-8179
Mailing Address - Fax:
Practice Address - Street 1:6311 NW HERMES CT
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986-3881
Practice Address - Country:US
Practice Address - Phone:954-296-8179
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-01
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA12142224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant