Provider Demographics
NPI:1952402521
Name:DAVIS, CAROL
Entity Type:Individual
Prefix:
First Name:CAROL
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 1:87892 225TH ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:MN
Mailing Address - Zip Code:56007-7682
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:700 1ST DR NW
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:MN
Practice Address - Zip Code:55912-3095
Practice Address - Country:US
Practice Address - Phone:763-689-5385
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN101449225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN6403339OtherMEDICA
MN8G688DAOtherBLUE CROSS BLUE SHIELD
MNHP45725OtherHEALTH PARTNERS
MN8G688DAOtherBLUE CROSS BLUE SHIELD