Individual
MRS. MISTY DELAINE DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
2015 VAUGHN RD NW, SUITE 130, KENNESAW, GA 30144-7801
(770) 425-6661
Mailing address
80 MOUNT TABOR CT, DALLAS, GA 30157-7133
(678) 343-3380
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
OT003187
GA
Other
Enumeration date
11/29/2006
Last updated
07/08/2007
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