Healthcare Provider Details

I. General information

NPI: 1982951489
Provider Name (Legal Business Name): CHRISTINE DAVIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2012
Last Update Date: 08/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1573 MATHIAS PKWY
GARDNERVILLE NV
89410-7966
US

IV. Provider business mailing address

1573 MATHIAS PKWY
GARDNERVILLE NV
89410-7966
US

V. Phone/Fax

Practice location:
  • Phone: 775-782-6620
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number11-0132
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: