=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740986991
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARQUITA SHENAE DAVIS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/31/2023
-----------------------------------------------------
Last Update Date | 12/05/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3095 KETTERING BLVD
-----------------------------------------------------
City | MORAINE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45439-1983
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-293-8300
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7010 HERCULES WAY
-----------------------------------------------------
City | WAYNESVILLE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45068-7505
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-248-5162
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041S0200X
-----------------------------------------------------
Taxonomy Name | School Social Worker
-----------------------------------------------------
License Number | C.2506455-TRNE
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------