Provider Demographics
NPI:1336529445
Name:DAMATO, AMY KATHRYN (OTR/L)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:KATHRYN
Last Name:DAMATO
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 SADDLE HILL CIR
Mailing Address - Street 2:
Mailing Address - City:NEWINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06111-1826
Mailing Address - Country:US
Mailing Address - Phone:860-878-6959
Mailing Address - Fax:
Practice Address - Street 1:19 SADDLE HILL CIR
Practice Address - Street 2:
Practice Address - City:NEWINGTON
Practice Address - State:CT
Practice Address - Zip Code:06111-1826
Practice Address - Country:US
Practice Address - Phone:860-878-6959
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-03
Last Update Date:2015-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002621172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker