Individual
GABRIELLE GRACE DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
1130 STATELINE RD E STE D, SOUTHAVEN, MS 38671-8701
(662) 536-6884
(662) 510-5892
Mailing address
1130 STATELINE RD E STE D, SOUTHAVEN, MS 38671-8701
(662) 536-6884
(662) 510-5892
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OTA3999
MS
Other
Enumeration date
05/04/2024
Last updated
05/04/2024
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