Provider Demographics
NPI:1639556947
Name:DAVIS, MICHELLE JACINDA (CTRS, VHA-CM)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:JACINDA
Last Name:DAVIS
Suffix:
Gender:F
Credentials:CTRS, VHA-CM
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Other - First Name:
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Mailing Address - Street 1:1601 SW ARCHER RD # 11I
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-1135
Mailing Address - Country:US
Mailing Address - Phone:352-264-7361
Mailing Address - Fax:352-264-3873
Practice Address - Street 1:1601 SW ARCHER RD # 11I
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608-1135
Practice Address - Country:US
Practice Address - Phone:352-264-7361
Practice Address - Fax:352-264-3873
Is Sole Proprietor?:No
Enumeration Date:2015-05-06
Last Update Date:2015-05-06
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist