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NPI Code Detail

MEDICARE: MS. PHYLLIS C. DAVIS M.ED., M.S. ED.

MEDICARE:  MS. PHYLLIS C. DAVIS  M.ED., M.S. 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
1103TS0200XSchool PsychologistKY1014651OH

General Provider Information

NPI Number : 1851630594
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. PHYLLIS C. DAVIS M.ED., M.S. ED.
Provider Business Mailing Address
First Line : 11484 OXFORDSHIRE LN
Second Line :
City : CINCINNATI
State : OH
Zip : 45240-2135
Country : US
Telephone Number : 513-742-2423
Fax Number : 513-891-2930
Provider Business Practice Location Address
First Line : 4131 MATSON AVE
Second Line :
City : CINCINNATI
State : OH
Zip : 45236-2509
Country : US
Telephone Number : 513-936-5923
Fax Number : 513-891-2930
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/31/2013
Last Update Date : 01/31/2013

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Directions to “ MS. PHYLLIS C. DAVIS M.ED., M.S. ED.” Practice Location

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