MEDICARE: LEKEISHA DAVIS-BLAIR

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	106S00000X	Behavior Technician
2	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1841913662
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEKEISHA DAVIS-BLAIR

Provider Business Mailing Address
First Line	:	PO BOX 289
Second Line	:
City	:	MASON
State	:	MI
Zip	:	48854-0289
Country	:	US
Telephone Number	:	517-676-5405
Fax Number	:

Provider Business Practice Location Address
First Line	:	38271 MOUND RD STE 300
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48310-3403
Country	:	US
Telephone Number	:	586-477-2054
Fax Number	:

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

Provider Enumeration Date	:	09/26/2022
Last Update Date	:	09/15/2023

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