Provider Demographics
NPI:1992989313
Name:DAVIS, PATRICIA (OTR/L,CHT)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
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:PO BOX 223056
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33422-3056
Mailing Address - Country:US
Mailing Address - Phone:561-632-0767
Mailing Address - Fax:561-793-3497
Practice Address - Street 1:1002 S OLD DIXIE HWY
Practice Address - Street 2:SUITE 105
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-7202
Practice Address - Country:US
Practice Address - Phone:561-632-0767
Practice Address - Fax:561-793-3497
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-20
Last Update Date:2010-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT1422225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL881414700Medicaid
FL0709950001Medicare NSC
FLZ4476AMedicare PIN
FL881414700Medicaid