Provider Demographics
NPI:1043494594
Name:DAVIS, LAUREL ANNE
Entity Type:Individual
Prefix:
First Name:LAUREL
Middle Name:ANNE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5901 POTTERS RD
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28104-0505
Mailing Address - Country:US
Mailing Address - Phone:704-618-0803
Mailing Address - Fax:
Practice Address - Street 1:3022 CHISHOLM CT
Practice Address - Street 2:
Practice Address - City:WAXHAW
Practice Address - State:NC
Practice Address - Zip Code:28173-7865
Practice Address - Country:US
Practice Address - Phone:704-843-2020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-19
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner