Provider Demographics
NPI:1891074878
Name:DAMSCHEN, LARAE S (LMP)
Entity Type:Individual
Prefix:
First Name:LARAE
Middle Name:S
Last Name:DAMSCHEN
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 1:40849 SCENIC DR N
Mailing Address - Street 2:
Mailing Address - City:SEVEN BAYS
Mailing Address - State:WA
Mailing Address - Zip Code:99122-8818
Mailing Address - Country:US
Mailing Address - Phone:509-725-3904
Mailing Address - Fax:509-725-3904
Practice Address - Street 1:100 3RD ST STE 2
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:WA
Practice Address - Zip Code:99122-5008
Practice Address - Country:US
Practice Address - Phone:509-348-0293
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-09
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60202019225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist