Healthcare Provider Details

I. General information

NPI: 1609110063
Provider Name (Legal Business Name): JENNIFER LYNN DAVIS MS, OTR/L, SCFES, SW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/23/2012
Last Update Date: 10/14/2024
Certification Date: 10/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2262 N 1ST ST
SAN JOSE CA
95131-2022
US

IV. Provider business mailing address

2262 N 1ST ST
SAN JOSE CA
95131-2022
US

V. Phone/Fax

Practice location:
  • Phone: 408-337-2727
  • Fax: 408-478-4130
Mailing address:
  • Phone: 408-337-2727
  • Fax: 408-478-4130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XF0002X
TaxonomyFeeding, Eating & Swallowing Occupational Therapist
License Number11766
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225XM0800X
TaxonomyMental Health Occupational Therapist
License Number11766
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number11766
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: