Provider Demographics
NPI:1801428321
Name:DAVIS, ALLISON NICOLE (MS OTR/L)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:NICOLE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MS OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 SEAPORT LN UNIT 2316
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-3780
Mailing Address - Country:US
Mailing Address - Phone:937-479-3930
Mailing Address - Fax:
Practice Address - Street 1:85 VINCENT DR # C
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-4066
Practice Address - Country:US
Practice Address - Phone:843-425-7963
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-12
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCOT.5771225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics