Provider Demographics
NPI:1164746293
Name:CUNNINGHAM-DAVENPORT, DEMETRIA KEMYATTA
Entity Type:Individual
Prefix:
First Name:DEMETRIA
Middle Name:KEMYATTA
Last Name:CUNNINGHAM-DAVENPORT
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 1:16000 W 9 MILE RD
Mailing Address - Street 2:STE 500
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-4802
Mailing Address - Country:US
Mailing Address - Phone:313-655-3860
Mailing Address - Fax:866-285-9802
Practice Address - Street 1:16000 W 9 MILE RD
Practice Address - Street 2:STE 500
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-4802
Practice Address - Country:US
Practice Address - Phone:313-655-3860
Practice Address - Fax:866-285-9802
Is Sole Proprietor?:No
Enumeration Date:2010-03-18
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist