MEDICARE: MS. CARRIE T DAVIS OTR/L

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	225XP0200X	Pediatric Occupational Therapist

General Provider Information

NPI Number	:	1528492527
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CARRIE T DAVIS OTR/L

Provider Business Mailing Address
First Line	:	PO BOX 367
Second Line	:
City	:	MOUNT TABOR
State	:	NJ
Zip	:	07878-0367
Country	:	US
Telephone Number	:	201-926-8905
Fax Number	:

Provider Business Practice Location Address
First Line	:	5 TOWNSQUARE
Second Line	:	STE A
City	:	CHATHAM
State	:	NJ
Zip	:	07928-2568
Country	:	US
Telephone Number	:	201-926-8905
Fax Number	:

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

Provider Enumeration Date	:	08/26/2013
Last Update Date	:	08/26/2013

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