Healthcare Provider Details

I. General information

NPI: 1295368595
Provider Name (Legal Business Name): KAREN DAVIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2020
Last Update Date: 02/15/2020
Certification Date: 02/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9719 CANDELARIA RD NE # 20945
ALBUQUERQUE NM
87111-9211
US

IV. Provider business mailing address

7112 PAN AMERICAN EAST FWY NE UNIT 97
ALBUQUERQUE NM
87109-4217
US

V. Phone/Fax

Practice location:
  • Phone: 505-977-5904
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: