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General NPI Number Information
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NPI Number | 1811400773
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Entity Type | Individual
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Provider Name | JANIS LAURSEN DAVIS OTR/L PHD
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Gender | Female
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Dates
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Enumeration Date | 11/14/2017
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Last Update Date | 11/14/2017
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Provider Practice Location Address
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Address Line | 27136 PASEO ESPADA
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City | SAN JUAN CAPISTRANO
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State | CA
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Zip | 92675-2728
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Country | US
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Telephone | 949-429-3220
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Fax |
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Provider Business Mailing Address
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Address Line | 1570 VIA CAPRI APT 5
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City | LAGUNA BEACH
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State | CA
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Zip | 92651-1362
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Country | US
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Telephone | 913-449-7757
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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 | 10768
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License Number State | CA
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