MEDICARE: LATRELL 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	106S00000X	Behavior Technician
2	225X00000X	Occupational Therapist	OT013637	OH

General Provider Information

NPI Number	:	1740981547
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LATRELL DAVIS

Provider Business Mailing Address
First Line	:	1041 TUDOR RD
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45419-3722
Country	:	US
Telephone Number	:	513-464-4546
Fax Number	:

Provider Business Practice Location Address
First Line	:	136 S LUDLOW ST
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45402-1813
Country	:	US
Telephone Number	:	513-464-4546
Fax Number	:

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

Provider Enumeration Date	:	03/17/2023
Last Update Date	:	05/28/2026

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Directions to “ LATRELL DAVIS ” Practice Location

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