Provider Demographics
NPI:1467806497
Name:DAMON, JAMIE LYNN (LMT)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:LYNN
Last Name:DAMON
Suffix:
Gender:
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20506 W BANNOCK AVE
Mailing Address - Street 2:
Mailing Address - City:MEDICAL LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99022-9628
Mailing Address - Country:US
Mailing Address - Phone:509-218-7604
Mailing Address - Fax:
Practice Address - Street 1:20506 W BANNOCK AVE
Practice Address - Street 2:
Practice Address - City:MEDICAL LAKE
Practice Address - State:WA
Practice Address - Zip Code:99022-9628
Practice Address - Country:US
Practice Address - Phone:509-218-7604
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-15
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60656876225700000X
225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty