MEDICARE: HEATHER L DAVIS LMT

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	174400000X	Specialist

General Provider Information

NPI Number	:	1790032779
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER L DAVIS LMT

Provider Business Mailing Address
First Line	:	2048 WHITEHORN DR N
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-3730
Country	:	US
Telephone Number	:	719-650-4471
Fax Number	:	719-531-0880

Provider Business Practice Location Address
First Line	:	1802 CHAPEL HILLS DR STE E
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-3736
Country	:	US
Telephone Number	:	719-531-7188
Fax Number	:	719-531-0880

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

Provider Enumeration Date	:	08/09/2012
Last Update Date	:	08/09/2012

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