MEDICARE: MICHELLE DAVIS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225XP0200X	Pediatric Occupational Therapist

General Provider Information

NPI Number	:	1033762455
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE DAVIS

Provider Business Mailing Address
First Line	:	915 ALPER CENTER DR UNIT 6109
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89052-1541
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	915 ALPER CENTER DR UNIT 6109
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89052-1541
Country	:	US
Telephone Number	:	843-531-7920
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/24/2019
Last Update Date	:	01/29/2022

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Directions to “ MICHELLE DAVIS ” Practice Location

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