MEDICARE: MRS. TALEKA DARVELL DAVIS LMP

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	172M00000X	Mechanotherapist	MA60288209	WA

General Provider Information

NPI Number	:	1235491481
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TALEKA DARVELL DAVIS LMP

Provider Business Mailing Address
First Line	:	1140 140TH AVE NE STE A
Second Line	:
City	:	BELLEVUE
State	:	WA
Zip	:	98005-2975
Country	:	US
Telephone Number	:	425-957-0761
Fax Number	:	425-957-1156

Provider Business Practice Location Address
First Line	:	1140 140TH AVE NE STE A
Second Line	:
City	:	BELLEVUE
State	:	WA
Zip	:	98005-2975
Country	:	US
Telephone Number	:	425-957-0761
Fax Number	:	425-957-1156

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

Provider Enumeration Date	:	06/13/2012
Last Update Date	:	06/13/2012

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