Healthcare Provider Details

I. General information

NPI: 1659660405
Provider Name (Legal Business Name): ANITA LOUISE HOTH-DAVIS OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANITA DAVIS OTR

II. Dates (important events)

Enumeration Date: 04/01/2011
Last Update Date: 04/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3306 E 105TH TER
KANSAS CITY MO
64137-1606
US

IV. Provider business mailing address

3306 E 105TH TER
KANSAS CITY MO
64137-1606
US

V. Phone/Fax

Practice location:
  • Phone: 303-507-7431
  • Fax: 913-663-1515
Mailing address:
  • Phone: 303-507-7431
  • Fax: 913-663-1515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number2010021565
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number17-02702
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: