Provider Demographics
NPI:1972861805
Name:DAVIS, MARTHA YVETTE (LMT)
Entity Type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:YVETTE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2341 BOSTON RD STE 301
Mailing Address - Street 2:
Mailing Address - City:WILBRAHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01095-1152
Mailing Address - Country:US
Mailing Address - Phone:413-348-9339
Mailing Address - Fax:
Practice Address - Street 1:2341 BOSTON RD STE 301
Practice Address - Street 2:
Practice Address - City:WILBRAHAM
Practice Address - State:MA
Practice Address - Zip Code:01095-1152
Practice Address - Country:US
Practice Address - Phone:413-348-9339
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-28
Last Update Date:2012-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9395225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist