MEDICARE: MS. KERMEISHA DAVENPORT 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	056.006109	IL

General Provider Information

NPI Number	:	1831356930
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KERMEISHA DAVENPORT OTR/L

Provider Business Mailing Address
First Line	:	1405 N. HARLEM
Second Line	:	UNIT C
City	:	OAK PARK
State	:	IL
Zip	:	60302
Country	:	US
Telephone Number	:	312-810-0214
Fax Number	:

Provider Business Practice Location Address
First Line	:	6641 S. ARTESIAN
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60629
Country	:	US
Telephone Number	:	312-810-0214
Fax Number	:

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

Provider Enumeration Date	:	05/18/2008
Last Update Date	:	10/10/2016

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