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General NPI Number Information
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NPI Number | 1205057049
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Entity Type | Individual
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Provider Name | GUSTAVIA C DAVIS LCOTA
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Gender | Female
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Dates
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Enumeration Date | 05/01/2007
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Last Update Date | 02/13/2013
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Provider Practice Location Address
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Address Line | 1306 W ADMIRAL DOYLE DR
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City | NEW IBERIA
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State | LA
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Zip | 70560-8552
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Country | US
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Telephone | 337-364-5472
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Fax |
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Provider Business Mailing Address
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Address Line | 8551 OLIVER AVE
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City | BATON ROUGE
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State | LA
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Zip | 70809-1730
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Country | US
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Telephone | 225-716-2880
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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 | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | OTA.Z20612
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License Number State | LA
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