Provider Demographics
NPI:1558620914
Name:DAVIS, PAMELA YVETTE
Entity Type:Individual
Prefix:MISS
First Name:PAMELA
Middle Name:YVETTE
Last Name:DAVIS
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 1:1801 LONDON CREST DR APT 137
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32818-7004
Mailing Address - Country:US
Mailing Address - Phone:407-437-8455
Mailing Address - Fax:
Practice Address - Street 1:1801 LONDON CREST DRIVE APT 137
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32818
Practice Address - Country:US
Practice Address - Phone:407-437-8455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-04
Last Update Date:2017-10-03
Deactivation Date:2015-05-06
Deactivation Code:
Reactivation Date:2017-10-03
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist