Provider Demographics
NPI:1962563809
Name:DAVIS, JOCELYN D (OTR L CHT)
Entity type:Individual
Prefix:
First Name:JOCELYN
Middle Name:D
Last Name:DAVIS
Suffix:
Gender:F
Credentials:OTR L CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16150 NE 85TH STREET
Mailing Address - Street 2:SUITE 116
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052
Mailing Address - Country:US
Mailing Address - Phone:425-881-1921
Mailing Address - Fax:425-861-7492
Practice Address - Street 1:16150 NE 85TH STREET
Practice Address - Street 2:SUITE 116
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052
Practice Address - Country:US
Practice Address - Phone:425-881-1921
Practice Address - Fax:425-861-7492
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT00001825225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8339541Medicaid
WAAB12903Medicare ID - Type Unspecified