MEDICARE: MRS. MARY ANNE DAVIS HOME HEALTH

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	376J00000X	Homemaker	2318343	OH

General Provider Information

NPI Number	:	1750432134
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARY ANNE DAVIS HOME HEALTH

Provider Business Mailing Address
First Line	:	2266 SEMINOLE AVE
Second Line	:
City	:	SPRINGFIELD
State	:	OH
Zip	:	45506-3241
Country	:	US
Telephone Number	:	937-284-7664
Fax Number	:	937-284-7664

Provider Business Practice Location Address
First Line	:	2266 SEMINOLE AVE
Second Line	:
City	:	SPRINGFIELD
State	:	OH
Zip	:	45506-3241
Country	:	US
Telephone Number	:	937-284-7664
Fax Number	:	937-284-7664

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

Provider Enumeration Date	:	01/14/2007
Last Update Date	:	07/08/2007

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