Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist | 1284005 | TX |
NPI | 1104314780 |
---|---|
Provider Name | Keisha Davis |
First Address | Houston, TX 77035-3313 |
Second Address | Houston, TX 77035-3313 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/04/2018 |
Last Update Date | 29/04/2018 |