Provider Demographics
NPI:1780056580
Name:AMY SMITH LLC
Entity type:Organization
Organization Name:AMY SMITH LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-740-5443
Mailing Address - Street 1:8305 SE MONTEREY AVE
Mailing Address - Street 2:SUITE #220-J
Mailing Address - City:HAPPY VALLEY
Mailing Address - State:OR
Mailing Address - Zip Code:97086-7725
Mailing Address - Country:US
Mailing Address - Phone:503-740-5443
Mailing Address - Fax:866-535-1121
Practice Address - Street 1:8305 SE MONTEREY AVE
Practice Address - Street 2:SUITE #220-J
Practice Address - City:HAPPY VALLEY
Practice Address - State:OR
Practice Address - Zip Code:97086-7725
Practice Address - Country:US
Practice Address - Phone:503-740-5443
Practice Address - Fax:866-535-1121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-20
Last Update Date:2015-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty