MEDICARE: CATHY DAVIS OT/L, CPAM, CLT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225XP0019X	Physical Rehabilitation Occupational Therapist	04309	MD

General Provider Information

NPI Number	:	1275290199
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CATHY DAVIS OT/L, CPAM, CLT

Provider Business Mailing Address
First Line	:	5437 LONG CORNER RD
Second Line	:
City	:	WHITE HALL
State	:	MD
Zip	:	21161-8900
Country	:	US
Telephone Number	:	443-613-3434
Fax Number	:

Provider Business Practice Location Address
First Line	:	5437 LONG CORNER RD
Second Line	:
City	:	WHITE HALL
State	:	MD
Zip	:	21161-8900
Country	:	US
Telephone Number	:	443-613-3434
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/27/2021
Last Update Date	:	11/27/2021

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