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General NPI Number Information
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NPI Number | 1144864521
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Entity Type | Individual
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Provider Name | BREANNE MARY DAVIS OTD, OTR/L
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Gender | Female
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Dates
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Enumeration Date | 10/29/2019
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Last Update Date | 10/29/2019
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Provider Practice Location Address
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Address Line | 2211 NE 139TH ST
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City | VANCOUVER
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State | WA
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Zip | 98686-2742
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Country | US
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Telephone | 360-487-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 8950 SW BRABHAM WAY
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City | GASTON
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State | OR
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Zip | 97119
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Country | US
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Telephone | 503-758-2280
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State | WA
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