Provider Demographics
NPI:1316089816
Name:DAVIS, RHONDA GAYLE
Entity type:Individual
Prefix:MRS
First Name:RHONDA
Middle Name:GAYLE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6850 S 127TH ST E
Mailing Address - Street 2:
Mailing Address - City:DERBY
Mailing Address - State:KS
Mailing Address - Zip Code:67037-9067
Mailing Address - Country:US
Mailing Address - Phone:316-776-0726
Mailing Address - Fax:
Practice Address - Street 1:1151 N ROCK RD
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-1262
Practice Address - Country:US
Practice Address - Phone:316-634-3424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
30471225800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
30471OtherNATIONAL TR CERTIFICATION