Provider Demographics
NPI:1720499916
Name:DAVIS, MARSHA (COTA)
Entity Type:Individual
Prefix:
First Name:MARSHA
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 JEMOND CT
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-5353
Mailing Address - Country:US
Mailing Address - Phone:407-600-4415
Mailing Address - Fax:
Practice Address - Street 1:213 JEMOND CT
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-5353
Practice Address - Country:US
Practice Address - Phone:407-600-4415
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-10
Last Update Date:2014-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX212628252Y00000X
FL13484252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLITINMedicare PIN