Provider Demographics
NPI:1891863767
Name:DAVIS, LINDA B (OTR-L)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:B
Last Name:DAVIS
Suffix:
Gender:F
Credentials:OTR-L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:893 310TH AVE
Mailing Address - Street 2:
Mailing Address - City:TAMA
Mailing Address - State:IA
Mailing Address - Zip Code:52339-8504
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:234 WEST ST S
Practice Address - Street 2:SOUTHVIEW PLAZA SUITE #4
Practice Address - City:GRINNELL
Practice Address - State:IA
Practice Address - Zip Code:50112-8160
Practice Address - Country:US
Practice Address - Phone:641-236-4506
Practice Address - Fax:641-236-4316
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2023-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01432225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0461624Medicaid
IA06735OtherBCBS
IA61777600OtherDEPT OF LABOR
IAI17007Medicare ID - Type Unspecified