Mieka Lise Davis, ATC, CMT

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

771AT Issued in MA

Practice address

20 South Street
Westborough, MA 01581

Phone

(508) 277-4156

NPI assigned

Jun 27, 2006

Last updated

Mar 31, 2015By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1151366400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1427760000000",
    "number": "1558398107",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "36 WORTHINGTON AVE",
            "city": "SHREWSBURY",
            "state": "MA",
            "postal_code": "01545",
            "telephone_number": "508-277-4156"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20 SOUTH STREET",
            "city": "WESTBOROUGH",
            "state": "MA",
            "postal_code": "01581",
            "telephone_number": "508-277-4156"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "MIEKA",
        "middle_name": "LISE",
        "name_prefix": "Mrs.",
        "credential": "ATC, CMT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-06-27",
        "last_updated": "2015-03-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "MA",
            "license": "771",
            "primary": false
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "MA",
            "license": "771AT",
            "primary": true
        },
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "MA",
            "license": "7426",
            "primary": false
        },
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "MA",
            "license": "7426MT",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Wendy Daly
• Dana R McMaster DMD LLC
• Fatima Darwish Elnashef, DDS
• David N Moheban DMD LLC
• Christine Anne Davidson
• Roxanne De Oliveira, LMHC
• Ann Marie B Deangelis, M.D.
• Michelle F Debest, N.P.
• Roberta Decker Kigner, LICSW
• Elizabeth R. Degrush, D.O.

• Athletic Trainer in Westborough, MA
• Providers in Westborough, MA by specialty
• Athletic Trainer in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.