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General NPI Number Information
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NPI Number | 1679776611
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Entity Type | Individual
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Provider Name | JUDY DAVIS OT
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Gender | Female
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Dates
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Enumeration Date | 06/07/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 690 N COFCO CENTER CT STE 260
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City | PHOENIX
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State | AZ
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Zip | 85008-6473
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Country | US
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Telephone | 520-227-9276
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Fax |
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Provider Business Mailing Address
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Address Line | P. O. BOX 817
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City | SIERRA VISTA
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State | AZ
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Zip | 85636
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Country | US
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Telephone | 520-417-2473
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Fax | 520-417-2473
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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 | 0101
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License Number State | AZ
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