MEDICARE: MRS. LINDA K. DAVIS M ED

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	222Q00000X	Developmental Therapist

General Provider Information

NPI Number	:	1164747358
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LINDA K. DAVIS M ED

Provider Business Mailing Address
First Line	:	140 FRANKLIN PL E
Second Line	:	APT206
City	:	LAKE FOREST
State	:	IL
Zip	:	60045-1273
Country	:	US
Telephone Number	:	224-544-5677
Fax Number	:	224-544-5677

Provider Business Practice Location Address
First Line	:	140 FRANKLIN PL E
Second Line	:	APT206
City	:	LAKE FOREST
State	:	IL
Zip	:	60045-1273
Country	:	US
Telephone Number	:	224-544-5677
Fax Number	:	224-544-5677

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

Provider Enumeration Date	:	03/31/2010
Last Update Date	:	08/05/2013

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