Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1041C0700X | Clinical Social Worker | C000131 | NC |
N | 2251P0200X | Physical Therapist - Pediatrics | 7452 | NC |
NPI | 1043314487 |
---|---|
Provider Name | Mrs. Sandra W. Davis |
First Address | Cullowhee, NC 28723-2318 |
Second Address | Sylva, NC 28779 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/09/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7210537 | (05) | NC |