Provider Demographics
NPI:1316164767
Name:DAVIS, KARIN GAIL (COTA)
Entity type:Individual
Prefix:MS
First Name:KARIN
Middle Name:GAIL
Last Name:DAVIS
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:MS
Other - First Name:KARIN
Other - Middle Name:GAIL
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA
Mailing Address - Street 1:7358 S GREEN ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60621-1614
Mailing Address - Country:US
Mailing Address - Phone:312-942-2786
Mailing Address - Fax:312-942-2086
Practice Address - Street 1:1653 W CONGRESS PKWY
Practice Address - Street 2:1325 KELLOGG
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3833
Practice Address - Country:US
Practice Address - Phone:312-942-2786
Practice Address - Fax:312-942-2086
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant