Individual
TERESA ANN DAVIDSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR L
Contact information
Practice address
1983 S FR 69, REPUBLIC, MO 65738
(417) 619-1424
Mailing address
1983 S FR 69, REPUBLIC, MO 65738
(417) 619-1424
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
2003020265
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
478617020
—
MO
Enumeration date
02/22/2007
Last updated
05/14/2008
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