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Individual

MS. GUSTAVIA C DAVIS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
LCOTA

Contact information

Practice address
1306 W ADMIRAL DOYLE DR, NEW IBERIA, LA 70560-8552
(337) 364-5472
Mailing address
8551 OLIVER AVE, BATON ROUGE, LA 70809-1730
(225) 716-2880

Taxonomy

Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OTA.Z20612
LA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
22
LCOTA
LA
Enumeration date
05/01/2007
Last updated
02/13/2013
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