MEDICARE: SHAWNDA RACHELLE 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	2991	MO

General Provider Information

NPI Number	:	1871733857
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAWNDA RACHELLE DAVIS OTR/L

Provider Business Mailing Address
First Line	:	8840 NW HWY B
Second Line	:
City	:	ROCKVILLE
State	:	MO
Zip	:	64780
Country	:	US
Telephone Number	:	660-492-0725
Fax Number	:

Provider Business Practice Location Address
First Line	:	7180 NW HIGHWAY B
Second Line	:
City	:	APPLETON CITY
State	:	MO
Zip	:	64724-3159
Country	:	US
Telephone Number	:	660-492-0725
Fax Number	:

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

Provider Enumeration Date	:	03/03/2009
Last Update Date	:	03/03/2009

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