Provider Demographics
NPI:1407248776
Name:SIMANTEL, AMY NOELLE (LMT)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:NOELLE
Last Name:SIMANTEL
Suffix:
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 1:111 SE 3RD AVE STE C
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97123-4036
Mailing Address - Country:US
Mailing Address - Phone:971-832-1498
Mailing Address - Fax:
Practice Address - Street 1:111 SE 3RD AVE STE C
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-4036
Practice Address - Country:US
Practice Address - Phone:971-832-1498
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-24
Last Update Date:2018-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR20712225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist