Healthcare Provider Details

I. General information

NPI: 1629490347
Provider Name (Legal Business Name): MARY DAVIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2014
Last Update Date: 09/13/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1341 CLARK ST
CAMBRIDGE OH
43725-9614
US

IV. Provider business mailing address

OHIO HEALTH SOUTHEASTERN MEDICAL SOUTHEASTERN OHIO REGI 1341 CLARK ST
CAMBRIDGE OH
43725-9614
US

V. Phone/Fax

Practice location:
  • Phone: 740-439-8975
  • Fax:
Mailing address:
  • Phone: 740-439-8977
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number011986
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: