Individual
MISS NICOLE JEANETTE DAVIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
11310 HORTON RD, GOODRICH, MI 48438-9497
(248) 561-5130
Mailing address
11310 HORTON RD, GOODRICH, MI 48438-9497
(248) 561-5130
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
L1360077
MI
Other
Enumeration date
03/02/2009
Last updated
03/02/2009
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