Healthcare Provider Details

I. General information

NPI: 1497408959
Provider Name (Legal Business Name): EMILY DAVISON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/03/2022
Last Update Date: 02/03/2022
Certification Date: 02/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81 BEAVER DAM RD
NORTH WATERBORO ME
04061-4732
US

IV. Provider business mailing address

81 BEAVER DAM RD
NORTH WATERBORO ME
04061-4732
US

V. Phone/Fax

Practice location:
  • Phone: 207-651-7535
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: