Individual
JENIECE DAVIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
11405 MEDLOCK BRIDGE RD, JOHNS CREEK, GA 30097-1688
(770) 814-0505
Mailing address
3201 REAGAN WAY, LAWRENCEVILLE, GA 30044-3494
(270) 991-8503
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OTA002774
GA
Other
Enumeration date
12/30/2021
Last updated
12/30/2021
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