Provider Demographics
NPI:1659841443
Name:DAVILA, SACI JEAN
Entity Type:Individual
Prefix:
First Name:SACI JEAN
Middle Name:
Last Name:DAVILA
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 1:635 VZ COUNTY ROAD 4605
Mailing Address - Street 2:
Mailing Address - City:BEN WHEELER
Mailing Address - State:TX
Mailing Address - Zip Code:75754-3465
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:635 VZ COUNTY ROAD 4605
Practice Address - Street 2:
Practice Address - City:BEN WHEELER
Practice Address - State:TX
Practice Address - Zip Code:75754-3465
Practice Address - Country:US
Practice Address - Phone:903-368-0485
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-05
Last Update Date:2018-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4207224Z00000X
OR386327224Z00000X
WAOC60864021224Z00000X
TX214647224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant