Provider Demographics
NPI:1275746505
Name:DAVIS, KATHERINE L (PT)
Entity Type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:L
Last Name:DAVIS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 TELFORD AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45419-3224
Mailing Address - Country:US
Mailing Address - Phone:937-974-6143
Mailing Address - Fax:937-832-8973
Practice Address - Street 1:1250 NATIONAL RD
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:OH
Practice Address - Zip Code:45315-9505
Practice Address - Country:US
Practice Address - Phone:937-832-8982
Practice Address - Fax:937-832-8973
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH07815174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist