Provider Demographics
NPI:1447707096
Name:DAVIDSON, CRISTY MARIE (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:CRISTY
Middle Name:MARIE
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 MAIN STREET
Mailing Address - Street 2:PO BOX 11
Mailing Address - City:BRITTON
Mailing Address - State:SD
Mailing Address - Zip Code:57430-0011
Mailing Address - Country:US
Mailing Address - Phone:605-448-1119
Mailing Address - Fax:605-448-1140
Practice Address - Street 1:413 9TH ST
Practice Address - Street 2:
Practice Address - City:BRITTON
Practice Address - State:SD
Practice Address - Zip Code:57430-2274
Practice Address - Country:US
Practice Address - Phone:605-448-2253
Practice Address - Fax:605-448-1140
Is Sole Proprietor?:No
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0405225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist