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1639768880 NPI number — MELISSA B DAVIS OTR

NPI Number: 1639768880
Health Care Provider/Practitioner: MELISSA B DAVIS OTR

Information about “1639768880” NPI (MELISSA B DAVIS OTR) exists in 1639768880 in HTML format HTML  |  1639768880 in plain Text format TXT  |  1639768880 in PDF (Portable Document Format) PDF  |  1639768880 in an XML format XML  formats.

NPI Number : 1639768880 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1639768880",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "DAVIS",
    "FirstName": "MELISSA",
    "MiddleName": "B",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "OTR",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "401 S GAYLE AVE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "BUNKIE",
    "MailingAddressStateName": "LA",
    "MailingAddressPostalCode": "71322-2223",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "770-815-0877",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1123 SHIRLEY RD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "BUNKIE",
    "PracticeLocationAddressStateName": "LA",
    "PracticeLocationAddressPostalCode": "71322-1553",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "318-346-3312",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "01/12/2021",
    "LastUpdateDate": "01/12/2021",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "225X00000X",
        "TaxonomyName": "Occupational Therapist",
        "LicenseNumber": "OTT.Z10913",
        "LicenseNumberStateCode": "LA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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