Provider Demographics
NPI:1104372945
Name:DAVIS, EMILY CANDLER (LMT, CLT, BCTMB)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:CANDLER
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LMT, CLT, BCTMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 MAIN ST
Mailing Address - Street 2:P.O. BOX 71
Mailing Address - City:SEAL HARBOR
Mailing Address - State:ME
Mailing Address - Zip Code:04675
Mailing Address - Country:US
Mailing Address - Phone:207-266-6822
Mailing Address - Fax:
Practice Address - Street 1:8 MAIN ST
Practice Address - Street 2:
Practice Address - City:SEAL HARBOR
Practice Address - State:ME
Practice Address - Zip Code:04675
Practice Address - Country:US
Practice Address - Phone:207-266-6822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-31
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMT 1443225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist