Provider Demographics
NPI:1659527216
Name:DAMOTA, KATIE SUE (IBCLC, MAS)
Entity Type:Individual
Prefix:MS
First Name:KATIE
Middle Name:SUE
Last Name:DAMOTA
Suffix:
Gender:F
Credentials:IBCLC, MAS
Other - Prefix:MS
Other - First Name:KATIE
Other - Middle Name:SUE
Other - Last Name:BOWMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:107 WEST MAIN STREET
Mailing Address - Street 2:#B
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945
Mailing Address - Country:US
Mailing Address - Phone:530-637-8411
Mailing Address - Fax:
Practice Address - Street 1:107 WEST MAIN STREET
Practice Address - Street 2:#B
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945
Practice Address - Country:US
Practice Address - Phone:530-637-8411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-14
Last Update Date:2015-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist