Individual
BRANTLEY WARREN DAVIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
COTA
Contact information
Practice address
19 N MILL ST, SUMRALL, MS 39482-4035
(601) 466-9638
Mailing address
19 N MILL ST, SUMRALL, MS 39482-4035
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
211203
TX
Other
Enumeration date
10/18/2011
Last updated
10/18/2011
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