Provider Demographics
NPI:1487916722
Name:DAVIS, TERRYN D'ALESSANDRO (OT)
Entity type:Individual
Prefix:MS
First Name:TERRYN
Middle Name:D'ALESSANDRO
Last Name:DAVIS
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4435 DIAMOND ST APT 4
Mailing Address - Street 2:
Mailing Address - City:CAPITOLA
Mailing Address - State:CA
Mailing Address - Zip Code:95010-3041
Mailing Address - Country:US
Mailing Address - Phone:831-430-6126
Mailing Address - Fax:
Practice Address - Street 1:4435 DIAMOND ST APT 4
Practice Address - Street 2:
Practice Address - City:CAPITOLA
Practice Address - State:CA
Practice Address - Zip Code:95010-3041
Practice Address - Country:US
Practice Address - Phone:831-430-6126
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-12
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5407225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation