Madison Renee Davis, COTA/L

Individual provider Active NPI Occupational Therapy Assistant · Desloge, MO

NPI 1669296463 · NPPES record last updated Nov 9, 2024

Key facts

NPI
1669296463
Entity type
Individual (NPI type 1)
Primary specialty
Occupational Therapy Assistant 224Z00000X
Practice address
801 Brim St
Desloge, MO 63601-3441
Phone
(573) 431-0223
NPI assigned
Nov 9, 2024
Sex
Female
Sole proprietor
No

Medicare participation

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

National Provider Directory

Medicare enrollment (NPD)
No

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapy Assistant 224Z00000X Yes

Addresses

Primary practice location

801 Brim St
Desloge, MO 63601-3441

Mailing address

801 Brim St
Desloge, MO 63601-3441
Phone (573) 431-0223

Other providers in Desloge, MO

All providers in Desloge, MO · Occupational Therapy Assistant in Missouri

Sources for this page

Verify at the official NPI Registry.