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1831602895 NPI number — KATIE RENEE DAVIDSON COTA/L

NPI Number: 1831602895
Health Care Provider/Practitioner: KATIE RENEE DAVIDSON COTA/L

Information about “1831602895” NPI (KATIE RENEE DAVIDSON COTA/L) exists in 1831602895 in HTML format HTML  |  1831602895 in plain Text format TXT  |  1831602895 in PDF (Portable Document Format) PDF  |  1831602895 in an XML format XML  formats.

NPI Number : 1831602895 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1831602895",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "DAVIDSON",
    "FirstName": "KATIE",
    "MiddleName": "RENEE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "COTA/L",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "DAVIDSON",
    "OtherFirstName": "KATIE",
    "OtherMiddleName": "RENEE",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "COTA/L",
    "OtherLastNameTypeCode": "2",
    "FirstLineMailingAddress": "2941 N DAVIS ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "LAVACA",
    "MailingAddressStateName": "AR",
    "MailingAddressPostalCode": "72941-4517",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "479-806-2879",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "2941 N DAVIS ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "LAVACA",
    "PracticeLocationAddressStateName": "AR",
    "PracticeLocationAddressPostalCode": "72941-4517",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "479-806-2879",
    "PracticeLocationAddressFaxNumber": "479-755-9960",
    "EnumerationDate": "11/13/2017",
    "LastUpdateDate": "11/12/2025",
    "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": "224Z00000X",
        "TaxonomyName": "Occupational Therapy Assistant",
        "LicenseNumber": "OT-A1225",
        "LicenseNumberStateCode": "AR",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY  GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
      }
    }
  }
}
                
            

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