Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | BOTOCT00222802 | KY |
NPI | 1710352919 |
---|---|
Provider Name | Michael Davis |
First Address | Georgetown, KY 40324-9610 |
Second Address | Georgetown, KY 40324-9610 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/12/2015 |
Last Update Date | 14/12/2015 |