Active NPI
Aundrea Davis, COTA/L
- Occupational Therapy Assistant
- Cleveland, TN
National Provider Identifier
1104582238
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapy Assistant
- License
- 1441
- Practice address
- 2255 Candies LN NW
Cleveland, TN 37312-2661 - Phone
- (423) 472-4700
- NPI assigned
- Nov 12, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapy Assistant | 224Z00000X | 1441 | TN | Primary |
Addresses
Primary practice location
2255 Candies LN NW
Cleveland, TN 37312-2661
Mailing address
518 Live Oak Rd
Ringgold, GA 30736-3195
Phone (423) 987-9737
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1441 | TN | MD | Behavioral Analyst |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1636675200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1636675200000",
"number": "1104582238",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "518 LIVE OAK RD",
"city": "RINGGOLD",
"state": "GA",
"postal_code": "307363195",
"telephone_number": "423-987-9737"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2255 CANDIES LN NW",
"city": "CLEVELAND",
"state": "TN",
"postal_code": "373122661",
"telephone_number": "423-472-4700"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAVIS",
"first_name": "AUNDREA",
"credential": "COTA/L",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-11-12",
"last_updated": "2021-11-12",
"certification_date": "2021-11-12",
"status": "A"
},
"taxonomies": [
{
"code": "224Z00000X",
"taxonomy_group": "",
"desc": "Occupational Therapy Assistant",
"state": "TN",
"license": "1441",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cleveland, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.