Basic Information
| Provider Information | |||||||||
| NPI: | 1922431170 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DAVIS | ||||||||
| FirstName: | JESSICA | ||||||||
| MiddleName: | M | ||||||||
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| OtherLastName: | BURWELL | ||||||||
| OtherFirstName: | JESSICA | ||||||||
| OtherMiddleName: | M | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 7292 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | OVID | ||||||||
| State: | NY | ||||||||
| PostalCode: | 145219586 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3156041602 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3399 WINTON RD S | ||||||||
| Address2: | |||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 14623 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5853346000 | ||||||||
| FaxNumber: | 5853342858 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/12/2013 | ||||||||
| LastUpdateDate: | 07/10/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 018387 | NY | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 225XE0001X | P90132 | NY | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Environmental Modification | 225XF0002X | P90132 | NY | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Feeding, Eating & Swallowing | 225XH1300X | P90132 | NY | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Human Factors | 225XP0200X | P90132 | NY | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Pediatrics | 225X00000X | P90132 | NY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.