Provider Demographics
NPI:1992085245
Name:DAVIDS, MICAH J
Entity type:Individual
Prefix:MR
First Name:MICAH
Middle Name:J
Last Name:DAVIDS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 CHURCH AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:MN
Mailing Address - Zip Code:56307-9489
Mailing Address - Country:US
Mailing Address - Phone:320-845-2195
Mailing Address - Fax:
Practice Address - Street 1:230 CHURCH AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:MN
Practice Address - Zip Code:56307-9489
Practice Address - Country:US
Practice Address - Phone:320-845-2195
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-18
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN105887225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI19172053Medicare PIN
IAI19172Medicare PIN