MEDICARE: MRS. SHELLEY ANN DAVIS NC LMBT

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	02173	NC

General Provider Information

NPI Number	:	1487398194
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHELLEY ANN DAVIS NC LMBT

Provider Business Mailing Address
First Line	:	113 PORTHOLE CT
Second Line	:
City	:	KILL DEVIL HILLS
State	:	NC
Zip	:	27948-9370
Country	:	US
Telephone Number	:	919-454-8402
Fax Number	:

Provider Business Practice Location Address
First Line	:	2603 N CROATAN HWY STE B
Second Line	:
City	:	KILL DEVIL HILLS
State	:	NC
Zip	:	27948-9588
Country	:	US
Telephone Number	:	919-454-8402
Fax Number	:

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

Provider Enumeration Date	:	04/27/2022
Last Update Date	:	04/27/2022

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