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General NPI Number Information
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NPI Number | 1659369007
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Entity Type | Individual
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Provider Name | KATHY J. DAVIS PHD, ATC, CSCS
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Gender | Female
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Dates
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Enumeration Date | 10/10/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 77 MASSACHUSETTS AVE W35-115
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City | CAMBRIDGE
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State | MA
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Zip | 02139-4301
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Country | US
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Telephone | 617-253-4908
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Fax |
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Provider Business Mailing Address
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Address Line | 16 PAUL AVE
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City | DERRY
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State | NH
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Zip | 03038-3803
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Country | US
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Telephone | 603-425-6335
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 11
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 8
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License Number State | NH
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