Provider Demographics
NPI:1316159353
Name:DAVIS, TASHUNDA LAMEKO (OTRL)
Entity type:Individual
Prefix:MISS
First Name:TASHUNDA
Middle Name:LAMEKO
Last Name:DAVIS
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25707 GAMEWOOD CT
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77386-1456
Mailing Address - Country:US
Mailing Address - Phone:772-323-7683
Mailing Address - Fax:
Practice Address - Street 1:25707 GAMEWOOD CT
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77386-1456
Practice Address - Country:US
Practice Address - Phone:772-323-7683
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011647225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist