Provider Demographics
NPI:1841644770
Name:DAVIS, SARA ELISE (OTD, OTR/L)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:ELISE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6341 ROCKFORD DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-5569
Mailing Address - Country:US
Mailing Address - Phone:719-242-4045
Mailing Address - Fax:
Practice Address - Street 1:2817 ROCK MERRITT AVE
Practice Address - Street 2:
Practice Address - City:FORT LIBERTY
Practice Address - State:NC
Practice Address - Zip Code:28310-4030
Practice Address - Country:US
Practice Address - Phone:109-078-9229
Practice Address - Fax:910-907-6069
Is Sole Proprietor?:No
Enumeration Date:2016-04-18
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1962225X00000X
COOT.0004876225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist