Healthcare Provider Details

I. General information

NPI: 1194647727
Provider Name (Legal Business Name): ALLIE DAVIDSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1241 VOLUNTEER PKWY STE 400
BRISTOL TN
37620-4635
US

IV. Provider business mailing address

1804 HERMITAGE DR
KINGSPORT TN
37664-3206
US

V. Phone/Fax

Practice location:
  • Phone: 423-473-7626
  • Fax: 423-573-7627
Mailing address:
  • Phone: 423-573-7626
  • Fax: 423-573-7627

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number8787
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: