Provider Demographics
NPI:1538923289
Name:DAVIES, JENIFER W (COTA)
Entity type:Individual
Prefix:
First Name:JENIFER
Middle Name:W
Last Name:DAVIES
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20992 ASHLEY LN
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-5865
Mailing Address - Country:US
Mailing Address - Phone:949-293-3080
Mailing Address - Fax:
Practice Address - Street 1:22672 LAMBERT ST
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-1613
Practice Address - Country:US
Practice Address - Phone:949-329-8161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-12
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6078224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant