Provider Demographics
NPI:1578393724
Name:DAVIS, CAROLINE (DOT)
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:DOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1049 S WISTERIA DR
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:PA
Mailing Address - Zip Code:19355-2330
Mailing Address - Country:US
Mailing Address - Phone:215-805-7234
Mailing Address - Fax:
Practice Address - Street 1:451 W RIDGE PIKE STE 479
Practice Address - Street 2:
Practice Address - City:LIMERICK
Practice Address - State:PA
Practice Address - Zip Code:19468-1415
Practice Address - Country:US
Practice Address - Phone:484-369-8953
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-02
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC019424225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist