Provider Demographics
NPI:1144348749
Name:DAMRON, MARIE JANET (OT CHT)
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:JANET
Last Name:DAMRON
Suffix:
Gender:F
Credentials:OT CHT
Other - Prefix:
Other - First Name:MARIE
Other - Middle Name:JANET
Other - Last Name:GLYNN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT CHT
Mailing Address - Street 1:1201 23RD ST
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301
Mailing Address - Country:US
Mailing Address - Phone:661-327-4357
Mailing Address - Fax:661-327-2311
Practice Address - Street 1:1831 TRUXTUN AVE
Practice Address - Street 2:SUITE 150
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-5026
Practice Address - Country:US
Practice Address - Phone:661-326-1433
Practice Address - Fax:661-326-1032
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2009-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT538225X00000X
CA9105000422225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ21295ZOtherMEDICARE GROUP PTAN
CAZZZ05291ZOtherMEDICARE INDIVIDUAL PTAN
CAZZZ05291ZOtherMEDICARE INDIVIDUAL PTAN