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General NPI Number Information
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NPI Number | 1407996440
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Entity Type | Individual
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Provider Name | ANTOINETTE DAVISSON OTR
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Gender | Female
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Dates
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Enumeration Date | 02/07/2007
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Last Update Date | 05/20/2010
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Provider Practice Location Address
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Address Line | 2601 FERRY ST
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City | LAFAYETTE
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State | IN
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Zip | 47904-3061
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Country | US
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Telephone | 765-448-8000
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 5545
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City | LAFAYETTE
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State | IN
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Zip | 47903-5545
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Country | US
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Telephone | 765-448-8000
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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 | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | OT8867
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 31002295A
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License Number State | IN
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