Individual
MRS. MIEKA LISE DAVIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ATC, CMT
Contact information
Practice address
20 SOUTH STREET, WESTBOROUGH, MA 01581
(508) 277-4156
Mailing address
36 WORTHINGTON AVE, SHREWSBURY, MA 01545
(508) 277-4156
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
771
MA
2255A2300X
Athletic Trainer
Primary
771AT
MA
225700000X
Massage Therapist
7426
MA
225700000X
Massage Therapist
7426MT
MA
Other
Enumeration date
06/27/2006
Last updated
03/31/2015
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