Healthcare Provider Details

I. General information

NPI: 1447214739
Provider Name (Legal Business Name): KECIA ANN DAVIS ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 W OLSEN RD
THOUSAND OAKS CA
91360-2700
US

IV. Provider business mailing address

60 W OLSEN RD
THOUSAND OAKS CA
91360-2700
US

V. Phone/Fax

Practice location:
  • Phone: 805-493-3406
  • Fax: 805-493-3860
Mailing address:
  • Phone: 805-493-3406
  • Fax: 805-493-3860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: