Healthcare Provider Details

I. General information

NPI: 1639690795
Provider Name (Legal Business Name): SHEILA DAVIS LMBT, COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1540 E ARLINGTON BLVD
GREENVILLE NC
27858-5870
US

IV. Provider business mailing address

1540 E ARLINGTON BLVD
GREENVILLE NC
27858-5870
US

V. Phone/Fax

Practice location:
  • Phone: 252-364-2806
  • Fax: 252-364-2863
Mailing address:
  • Phone: 252-364-2806
  • Fax: 252-364-2863

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number9644
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number05278
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: