Jodi Davison, OTR/L
Individual provider Active NPI Occupational Therapist · Canon, GA
NPI 1760748974 · NPPES record last updated Apr 2, 2012
Key facts
- NPI
- 1760748974
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Occupational Therapist 225X00000X
- License
- OT004821 (GA)
- Practice address
- 239 Grace Baptist Church Rd
Canon, GA 30520-4352 - Phone
- (706) 491-9017
- NPI assigned
- Apr 2, 2012
- Sex
- Female
- 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
| License | State | Type | Specialty |
|---|---|---|---|
| OT004821 | GA | MD | Occupational Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | OT004821 | GA | Yes |
Addresses
Primary practice location
239 Grace Baptist Church Rd
Canon, GA 30520-4352
Mailing address
239 Grace Baptist Church Rd
Canon, GA 30520-4352
Other providers in Canon, GA
All providers in Canon, GA · Occupational Therapist in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 2, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.