Individual
MRS. JEANINE PATRICIA DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
2350 TAFT ST, GARY, IN 46404-3349
(219) 977-2600
Mailing address
5299 LYNDELL AVE, PORTAGE, IN 46368-1847
(219) 763-6504
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
32000437A
IN
Other
Enumeration date
01/26/2012
Last updated
01/26/2012
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