MEDICARE: JUDY DAVIS OT

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	225X00000X	Occupational Therapist	0101	AZ

General Provider Information

NPI Number	:	1679776611
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUDY DAVIS OT

Provider Business Mailing Address
First Line	:	P. O. BOX 817
Second Line	:
City	:	SIERRA VISTA
State	:	AZ
Zip	:	85636
Country	:	US
Telephone Number	:	520-417-2473
Fax Number	:	520-417-2473

Provider Business Practice Location Address
First Line	:	690 N COFCO CENTER CT STE 260
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85008-6473
Country	:	US
Telephone Number	:	520-227-9276
Fax Number	:

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

Provider Enumeration Date	:	06/07/2007
Last Update Date	:	07/08/2007

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