MEDICARE: APRIL GRACE 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	225X00000X	Occupational Therapist	OT 10332	CA

General Provider Information

NPI Number	:	1811221948
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	APRIL GRACE DAVIS OTR/L

Provider Business Mailing Address
First Line	:	992 GROVE ST
Second Line	:	APT. A
City	:	HEALDSBURG
State	:	CA
Zip	:	95448-4761
Country	:	US
Telephone Number	:	707-972-1808
Fax Number	:

Provider Business Practice Location Address
First Line	:	311 PROFESSIONAL CENTER DR
Second Line	:	SUITE 100
City	:	ROHNERT PARK
State	:	CA
Zip	:	94928-2152
Country	:	US
Telephone Number	:	707-591-0170
Fax Number	:	707-591-0171

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

Provider Enumeration Date	:	09/22/2009
Last Update Date	:	09/22/2009

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