Provider Demographics
NPI:1497550859
Name:DAVIS, EDEN RAE (OTD, OTR/L)
Entity type:Individual
Prefix:
First Name:EDEN
Middle Name:RAE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:EDEN
Other - Middle Name:RAE
Other - Last Name:GRAMM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1601 LEWIS AVE STE 107
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-4182
Mailing Address - Country:US
Mailing Address - Phone:406-647-0042
Mailing Address - Fax:
Practice Address - Street 1:1601 LEWIS AVE STE 107
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-4182
Practice Address - Country:US
Practice Address - Phone:406-647-0042
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-18
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTOTP-OT-LIC-11651225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist