Healthcare Provider Details

I. General information

NPI: 1003721028
Provider Name (Legal Business Name): SAMANTHA MAY DAVIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1341 OHIO ST
TERRE HAUTE IN
47807-3940
US

IV. Provider business mailing address

424 N SYCAMORE ST
DANA IN
47847-8103
US

V. Phone/Fax

Practice location:
  • Phone: 812-266-0974
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: