Provider Demographics
NPI:1306252374
Name:DAVIS, LOLITA
Entity type:Individual
Prefix:
First Name:LOLITA
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 PLUMB AVE
Mailing Address - Street 2:
Mailing Address - City:MERIDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06450-6541
Mailing Address - Country:US
Mailing Address - Phone:203-537-6781
Mailing Address - Fax:855-878-8051
Practice Address - Street 1:140 PLUMB AVE
Practice Address - Street 2:
Practice Address - City:MERIDEN
Practice Address - State:CT
Practice Address - Zip Code:06450-6541
Practice Address - Country:US
Practice Address - Phone:203-537-6781
Practice Address - Fax:855-878-8051
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-10
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant