Provider Demographics
NPI:1184189557
Name:DAVENPORT, SKYLER M (ATC)
Entity Type:Individual
Prefix:
First Name:SKYLER
Middle Name:M
Last Name:DAVENPORT
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 S THOMPSON ST
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:MO
Mailing Address - Zip Code:64730
Mailing Address - Country:US
Mailing Address - Phone:660-424-3226
Mailing Address - Fax:
Practice Address - Street 1:420 S FULTON ST
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:MO
Practice Address - Zip Code:64730
Practice Address - Country:US
Practice Address - Phone:660-424-3226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-09
Last Update Date:2019-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20170350352255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer