Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter | CPED2005 | MI |
NPI | 1396971859 |
---|---|
Provider Name | Jeffrey V Davis |
First Address | Saginaw, MI 48603-2267 |
Second Address | Kalamazoo, MI 49001-4823 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2009 |
Last Update Date | 10/06/2009 |