MEDICARE: MR. KAREN JILL DAVIES LMT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	021092	NY

General Provider Information

NPI Number	:	1144419557
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KAREN JILL DAVIES LMT

Provider Business Mailing Address
First Line	:	286 YOUNG ST
Second Line	:
City	:	WILSON
State	:	NY
Zip	:	14172
Country	:	US
Telephone Number	:	716-531-5540
Fax Number	:

Provider Business Practice Location Address
First Line	:	286 YOUNG ST
Second Line	:
City	:	WILSON
State	:	NY
Zip	:	14172
Country	:	US
Telephone Number	:	716-531-5540
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/22/2007
Last Update Date	:	10/22/2007

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