Individual
SHANEILL DAVIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1509 W 95TH ST, LOS ANGELES, CA 90047-3915
(323) 500-8038
Mailing address
1509 W 95TH ST, LOS ANGELES, CA 90047-3915
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
323908
CA
Other
Enumeration date
01/05/2015
Last updated
01/05/2015
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