Provider Demographics
NPI:1467629691
Name:DAVIS, EILEEN SUSAN (CMT)
Entity Type:Individual
Prefix:
First Name:EILEEN
Middle Name:SUSAN
Last Name:DAVIS
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3222 C RD
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81503-9414
Mailing Address - Country:US
Mailing Address - Phone:970-255-1559
Mailing Address - Fax:
Practice Address - Street 1:2505 FORESIGHT CIR
Practice Address - Street 2:UNIT C-2
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81505-1081
Practice Address - Country:US
Practice Address - Phone:970-255-1559
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-16
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist