Provider Demographics
NPI:1710352919
Name:DAVIS, MICHAEL (MSOT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:DAVIS
Suffix:
Gender:M
Credentials:MSOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 WINDSOR PATH
Mailing Address - Street 2:SUITE 4
Mailing Address - City:GEORGETOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40324-9610
Mailing Address - Country:US
Mailing Address - Phone:502-863-3870
Mailing Address - Fax:502-863-1287
Practice Address - Street 1:103 WINDSOR PATH
Practice Address - Street 2:SUITE 4
Practice Address - City:GEORGETOWN
Practice Address - State:KY
Practice Address - Zip Code:40324-9610
Practice Address - Country:US
Practice Address - Phone:502-863-3870
Practice Address - Fax:502-863-1287
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-14
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYBOTOCT00222802225XN1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XN1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistNeurorehabilitation