Individual
NICOLE LYNN DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
128 N HARDESTY AVE, KANSAS CITY, MO 64123-1404
(816) 241-2020
Mailing address
3920 SW GRANITE LN, LEES SUMMIT, MO 64082-4846
(816) 721-2845
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
2018029156
MO
Other
Enumeration date
05/28/2019
Last updated
05/28/2019
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