Healthcare Provider Details

I. General information

NPI: 1467686220
Provider Name (Legal Business Name): AUDREY HOPKINS DAVIS OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2009
Last Update Date: 10/27/2020
Certification Date: 10/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2810 AMBASSADOR CAFFERY PKWY
LAFAYETTE LA
70506-5906
US

IV. Provider business mailing address

10 S 9TH ST STE 4
NOBLESVILLE IN
46060-2631
US

V. Phone/Fax

Practice location:
  • Phone: 337-981-2949
  • Fax: 337-989-6759
Mailing address:
  • Phone: 765-524-3946
  • Fax: 317-708-6496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOTT.200179
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: