Provider Demographics
NPI:1124079801
Name:DAVIS, JOHN SCOTT (OT)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:SCOTT
Last Name:DAVIS
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1844 E BASELINE RD STE C5
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-1506
Mailing Address - Country:US
Mailing Address - Phone:480-833-1005
Mailing Address - Fax:480-833-1312
Practice Address - Street 1:6840 E BROWN RD STE 104
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85207-3759
Practice Address - Country:US
Practice Address - Phone:480-719-8080
Practice Address - Fax:480-981-8595
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2020-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2478225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ2Z223OtherHEALTHNET
AZ753120978OtherAETNA
AZ753120978OtherHUMANA
AZAZ0463540OtherBCBS
AZP00234275OtherMEDICARE RAIL ROAD
AZ753120978OtherTRICARE
AZ753120978OtherBANNER LHPO
AZAZ0463540OtherBCBS