Individual
DAVEN ICAO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
COTA
Contact information
Practice address
1061 VIRGINIA ST, DUNEDIN, FL 34698-7326
(727) 733-4189
Mailing address
2159 NURSERY RD APT 321, CLEARWATER, FL 33764-2622
(386) 490-3171
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OTA12056
FL
Other
Enumeration date
10/25/2015
Last updated
10/25/2015
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