Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter |
NPI | 1295967610 |
---|---|
Provider Name | Miss Debra Ann Davis |
First Address | Chicago, IL 60612-3531 |
Second Address | Chicago, IL 60612-3531 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2009 |
Last Update Date | 18/08/2009 |