Julius Davis, COTA/L

Individual provider Active NPI Occupational Therapy Assistant · Tega Cay, SC

NPI 1275009474 · NPPES record last updated Oct 16, 2018

Key facts

NPI
1275009474
Entity type
Individual (NPI type 1)
Primary specialty
Occupational Therapy Assistant 224Z00000X
License
4870 (SC)
Practice address
111 Wellmore Dr
Tega Cay, SC 29708-0124
Phone
(803) 835-7059
NPI assigned
Oct 16, 2018
Sex
Male
Sole proprietor
Yes

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
4870SCMDSpeech-Language Assistant

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapy Assistant 224Z00000X 4870 SC Yes

Addresses

Primary practice location

111 Wellmore Dr
Tega Cay, SC 29708-0124

Mailing address

111 Wellmore Dr
Tega Cay, SC 29708-0124
Phone (803) 835-7059

Other providers in Tega Cay, SC

All providers in Tega Cay, SC · Occupational Therapy Assistant in South Carolina

Sources for this page

Verify at the official NPI Registry.