Healthcare Provider Details

I. General information

NPI: 1164792552
Provider Name (Legal Business Name): KRISTEN DAVIS O.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KRISTEN JULIAN

II. Dates (important events)

Enumeration Date: 01/03/2012
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 E 25TH AVE
COVINGTON LA
70433-2820
US

IV. Provider business mailing address

106 E 25TH AVE
COVINGTON LA
70433-2820
US

V. Phone/Fax

Practice location:
  • Phone: 985-327-5352
  • Fax:
Mailing address:
  • Phone: 985-327-5352
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOTT.200738
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: