Individual
MR. LUCAS BENJAMIN DAVIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OTR/L
Contact information
Practice address
51 SOUTHLAND DR, SUITE 2300, FAIRMONT, WV 26554-2244
(304) 363-3167
Mailing address
212 BRADDOCK ST, FAIRMONT, WV 26554-2208
(304) 288-2265
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
1143
WV
Other
Enumeration date
05/29/2009
Last updated
05/29/2009
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