MEDICARE: ROBIN D DAVIS CFOM

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	335E00000X	Prosthetic/Orthotic Supplier	HC0042	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	7795066	OTHER	NC	MASTECTOMY CERTIFIED FITT
2	7795241	OTHER	NC	ORTHOTIC CERTIFIED FITTER

General Provider Information

NPI Number	:	1073710729
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBIN D DAVIS CFOM

Provider Business Mailing Address
First Line	:	105 T R HARRIS DR
Second Line	:
City	:	SHELBY
State	:	NC
Zip	:	28150-3486
Country	:	US
Telephone Number	:	704-487-5225
Fax Number	:

Provider Business Practice Location Address
First Line	:	105 T R HARRIS DR
Second Line	:
City	:	SHELBY
State	:	NC
Zip	:	28150-3486
Country	:	US
Telephone Number	:	704-487-5225
Fax Number	:

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

Provider Enumeration Date	:	06/27/2007
Last Update Date	:	07/08/2007

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