Provider Demographics
NPI:1659606846
Name:DAMATO, MARTHA ANN (LMT)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:ANN
Last Name:DAMATO
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 1:22210 SW MURDOCK RD
Mailing Address - Street 2:APT A-3
Mailing Address - City:SHERWOOD
Mailing Address - State:OR
Mailing Address - Zip Code:97140-9764
Mailing Address - Country:US
Mailing Address - Phone:541-914-2984
Mailing Address - Fax:
Practice Address - Street 1:10500 SW GREENBURG RD
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-1406
Practice Address - Country:US
Practice Address - Phone:503-684-9698
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-06
Last Update Date:2009-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR9161171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor