MEDICARE: TRICIA SHEREEN DAVIDSON COTA/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	224Z00000X	Occupational Therapy Assistant	OTA12142	FL

General Provider Information

NPI Number	:	1871844746
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRICIA SHEREEN DAVIDSON COTA/L

Provider Business Mailing Address
First Line	:	6311 NW HERMES CT
Second Line	:
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34986-3881
Country	:	US
Telephone Number	:	954-296-8179
Fax Number	:

Provider Business Practice Location Address
First Line	:	6311 NW HERMES CT
Second Line	:
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34986-3881
Country	:	US
Telephone Number	:	954-296-8179
Fax Number	:

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

Provider Enumeration Date	:	10/01/2012
Last Update Date	:	02/26/2020

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