Healthcare Provider Details

I. General information

NPI: 1275440406
Provider Name (Legal Business Name): CATHLEEN LETICIA DAVIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11530 ALLISONVILLE RD STE 100
FISHERS IN
46038-1862
US

IV. Provider business mailing address

12388 BERRY PATCH LN
FISHERS IN
46037-4494
US

V. Phone/Fax

Practice location:
  • Phone: 317-903-2053
  • Fax:
Mailing address:
  • Phone: 317-903-2053
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: