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Individual

MRS. BEVERLY M DAVIS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
RBT

Contact information

Practice address
1808 16TH AVE N, LAKE WORTH, FL 33460-6447
(561) 667-3255
Mailing address
1808 16TH AVE N, LAKE WORTH, FL 33460-6447
(561) 667-3255

Taxonomy

Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
020408000
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
020408000
FL
Enumeration date
03/19/2019
Last updated
03/19/2019
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