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Individual
ANTOINETTE DAVISSON
Active
Individual
ANTOINETTE DAVISSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
31002295A
IN
225XP0200X
Pediatric Occupational Therapist
OT8867
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000604008
ANTHEM PROVIDER NUMBER
IN
05
—
200328240
—
IN
Enumeration date
02/07/2007
Last updated
05/20/2010
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