Individual
IAN DAVISSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1526 LOMBARD ST, PHILADELPHIA, PA 19146-1625
(678) 378-8328
Mailing address
1526 LOMBARD ST, PHILADELPHIA, PA 19146-1625
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OC014928
PA
Other
Enumeration date
09/15/2017
Last updated
09/15/2017
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