Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225CA2400X | Assistive Technology Practitioner |
NPI | 1902346042 |
---|---|
Provider Name | Jeffrey Samuel Davis |
First Address | Winter Garden, FL 34787-4652 |
Second Address | Winter Garden, FL 34787-4652 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/03/2017 |
Last Update Date | 19/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
018669400 | (05) | FL |