Individual
MISS JENNA DAVIES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
1020 HILL ST, WATERTOWN, WI 53098-3016
(920) 206-4935
Mailing address
N2720 HWY E, PALMYRA, WI 53156-9728
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
5122-27
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
224Z00000X
—
WI
Enumeration date
11/08/2014
Last updated
07/01/2024
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