Provider Demographics
NPI:1386828630
Name:DAVIS, JOE
Entity Type:Individual
Prefix:
First Name:JOE
Middle Name:
Last Name:DAVIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 DRURY LN
Mailing Address - Street 2:
Mailing Address - City:EASTBOROUGH
Mailing Address - State:KS
Mailing Address - Zip Code:67207-1004
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2020 N WOODLAWN ST
Practice Address - Street 2:SUITE 420
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67208-1852
Practice Address - Country:US
Practice Address - Phone:316-260-2424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-21
Last Update Date:2007-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS17-01230225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist