Basic Information
Provider Information
NPI: 1003149832
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: DAVIS
FirstName: TRISEL
MiddleName: MICHELLE
NamePrefix:  
NameSuffix:  
Credential: MOT, OTR
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 6802 LOST TIMBER LN
Address2:  
City: RICHMOND
State: TX
PostalCode: 774694471
CountryCode: US
TelephoneNumber: 2817250062
FaxNumber:  
Practice Location
Address1: 6802 LOST TIMBER LN
Address2:  
City: RICHMOND
State: TX
PostalCode: 774694471
CountryCode: US
TelephoneNumber: 2817250062
FaxNumber:  
Other Information
ProviderEnumerationDate: 09/11/2009
LastUpdateDate: 09/12/2009
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225X00000X103432TXY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist 
225XH1300X103432TXN Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHuman Factors
225XP0200X103432TXN Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
225XM0800X103432TXN Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistMental Health
225XE0001X103432TXN Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistEnvironmental Modification
225XF0002X103432TXN Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistFeeding, Eating & Swallowing
225XL0004X103432TXN Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistLow Vision

No ID Information.


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