Healthcare Provider Details

I. General information

NPI: 1548127913
Provider Name (Legal Business Name): MICHELLE M DAVIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2026
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35531 STEPHANIE ST
ROMULUS MI
48174-4528
US

IV. Provider business mailing address

35531 STEPHANIE ST
ROMULUS MI
48174-4528
US

V. Phone/Fax

Practice location:
  • Phone: 313-523-7676
  • Fax:
Mailing address:
  • Phone: 313-523-7676
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberD120734488450
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: