Provider Demographics
NPI:1427286210
Name:DAVIS, JESSICA L (MS, OTR/L)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:L
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30212 NE 178TH PL
Mailing Address - Street 2:
Mailing Address - City:DUVALL
Mailing Address - State:WA
Mailing Address - Zip Code:98019-7811
Mailing Address - Country:US
Mailing Address - Phone:425-443-6957
Mailing Address - Fax:
Practice Address - Street 1:13954 NE 60TH WAY
Practice Address - Street 2:STE. 110
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-4583
Practice Address - Country:US
Practice Address - Phone:425-890-0998
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-30
Last Update Date:2009-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT00002861225XG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontology