MEDICARE: MISS DEBRA ANN DAVIS

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	225000000X	Orthotic Fitter

General Provider Information

NPI Number	:	1295967610
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS DEBRA ANN DAVIS

Provider Business Mailing Address
First Line	:	610 S WESTERN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60612-3531
Country	:	US
Telephone Number	:	312-226-7145
Fax Number	:

Provider Business Practice Location Address
First Line	:	610 S WESTERN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60612-3531
Country	:	US
Telephone Number	:	312-226-9777
Fax Number	:	312-226-9767

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

Provider Enumeration Date	:	08/18/2009
Last Update Date	:	08/18/2009

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