Provider Demographics
NPI:1386915841
Name:DAVIS, DEREK WATKINS (OT)
Entity type:Individual
Prefix:
First Name:DEREK
Middle Name:WATKINS
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 1:12136 KAY DR
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:FL
Mailing Address - Zip Code:33772-2600
Mailing Address - Country:US
Mailing Address - Phone:740-550-1722
Mailing Address - Fax:
Practice Address - Street 1:9035 BRYAN DAIRY RD
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33777-1104
Practice Address - Country:US
Practice Address - Phone:727-395-9619
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-15
Last Update Date:2012-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT11584225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist