Provider Demographics
NPI:1073356861
Name:DAVIS, KATIE LYNN EVITTS (COTA/L)
Entity type:Individual
Prefix:
First Name:KATIE LYNN
Middle Name:EVITTS
Last Name:DAVIS
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 1:1563 SAM RITTENBERG BLVD
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-4248
Mailing Address - Country:US
Mailing Address - Phone:843-277-2411
Mailing Address - Fax:
Practice Address - Street 1:1563 SAM RITTENBERG BLVD
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-4248
Practice Address - Country:US
Practice Address - Phone:843-277-2411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-18
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCOTA.5677224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant