Provider Demographics
NPI:1205138807
Name:DAVIS, KATHLEEN
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:DAVIS
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 1:1111 COMMONS B;VD
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19605-3334
Mailing Address - Country:US
Mailing Address - Phone:610-987-8621
Mailing Address - Fax:610-987-8621
Practice Address - Street 1:1111 COMMONS B;VD
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19605-3334
Practice Address - Country:US
Practice Address - Phone:610-987-8621
Practice Address - Fax:610-987-8547
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-02
Last Update Date:2011-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency