Healthcare Provider Details

I. General information

NPI: 1124526587
Provider Name (Legal Business Name): CHELSEA JOY DAVIS MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2018
Last Update Date: 01/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12030 RAMONA AVE APT B
HAWTHORNE CA
90250-3697
US

IV. Provider business mailing address

12030 RAMONA AVE APT B
HAWTHORNE CA
90250-3697
US

V. Phone/Fax

Practice location:
  • Phone: 727-389-6481
  • Fax:
Mailing address:
  • Phone: 727-389-6481
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code225600000X
TaxonomyDance Therapist
License NumberR-DMT-2323
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: