Provider Demographics
NPI:1124748702
Name:DAVIDSON, MAKAYLA CHRISTINE (RBT)
Entity type:Individual
Prefix:
First Name:MAKAYLA
Middle Name:CHRISTINE
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1777 TAMIAMI TRL STE 304
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33948-1083
Mailing Address - Country:US
Mailing Address - Phone:813-528-7048
Mailing Address - Fax:855-610-2343
Practice Address - Street 1:1777 TAMIAMI TRL STE 304
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33948-1083
Practice Address - Country:US
Practice Address - Phone:813-528-7048
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-01
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician