Provider Demographics
NPI:1619118106
Name:DAVIS, MICHAEL SHAWN (CFO)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:SHAWN
Last Name:DAVIS
Suffix:
Gender:M
Credentials:CFO
Other - Prefix:
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Mailing Address - Street 1:208 LILLY RD NE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-6100
Mailing Address - Country:US
Mailing Address - Phone:360-459-1099
Mailing Address - Fax:360-459-1794
Practice Address - Street 1:208 LILLY RD NE
Practice Address - Street 2:
Practice Address - City:OLYMPAI
Practice Address - State:WA
Practice Address - Zip Code:98506
Practice Address - Country:US
Practice Address - Phone:360-459-1099
Practice Address - Fax:360-459-1794
Is Sole Proprietor?:No
Enumeration Date:2009-03-13
Last Update Date:2011-04-29
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter