Provider Demographics
NPI:1972754653
Name:DAVIS, CAROL ANN I (LMT)
Entity type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:ANN
Last Name:DAVIS
Suffix:I
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11611 RAMIREZ RD
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97603-8963
Mailing Address - Country:US
Mailing Address - Phone:541-281-3900
Mailing Address - Fax:
Practice Address - Street 1:11611 RAMIREZ RD
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97603-8963
Practice Address - Country:US
Practice Address - Phone:541-281-3900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-01
Last Update Date:2008-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR12166225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist