Provider Demographics
NPI:1609041912
Name:DAVIES, WAUNITA D (LMT)
Entity Type:Individual
Prefix:
First Name:WAUNITA
Middle Name:D
Last Name:DAVIES
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:NITA
Other - Middle Name:
Other - Last Name:DAVIES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1188 11TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:OR
Mailing Address - Zip Code:97321-2021
Mailing Address - Country:US
Mailing Address - Phone:541-908-3290
Mailing Address - Fax:
Practice Address - Street 1:1188 11TH AVE SW
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97321-2021
Practice Address - Country:US
Practice Address - Phone:541-908-3290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-28
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR7961225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist