Provider Demographics
NPI:1871733857
Name:DAVIS, SHAWNDA RACHELLE (OTR/L)
Entity type:Individual
Prefix:
First Name:SHAWNDA
Middle Name:RACHELLE
Last Name:DAVIS
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 1:8840 NW HWY B
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:64780
Mailing Address - Country:US
Mailing Address - Phone:660-492-0725
Mailing Address - Fax:
Practice Address - Street 1:7180 NW HIGHWAY B
Practice Address - Street 2:
Practice Address - City:APPLETON CITY
Practice Address - State:MO
Practice Address - Zip Code:64724-3159
Practice Address - Country:US
Practice Address - Phone:660-492-0725
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-03
Last Update Date:2009-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2991225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics