Provider Demographics
NPI:1194864207
Name:DAMEROW-MILTON, TONIA MARIE (LMP)
Entity Type:Individual
Prefix:
First Name:TONIA
Middle Name:MARIE
Last Name:DAMEROW-MILTON
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 N 43RD WAY
Mailing Address - Street 2:
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99301-2965
Mailing Address - Country:US
Mailing Address - Phone:509-546-0188
Mailing Address - Fax:
Practice Address - Street 1:316 N 20TH AVE
Practice Address - Street 2:
Practice Address - City:PASCO
Practice Address - State:WA
Practice Address - Zip Code:99301-4963
Practice Address - Country:US
Practice Address - Phone:509-547-9701
Practice Address - Fax:509-521-0102
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00022984225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist