Healthcare Provider Details

I. General information

NPI: 1831094101
Provider Name (Legal Business Name): AMANDA WATKINS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 NE DEKUM ST
PORTLAND OR
97211-2926
US

IV. Provider business mailing address

4910 N GANTENBEIN AVE APT 306
PORTLAND OR
97217-2856
US

V. Phone/Fax

Practice location:
  • Phone: 503-383-9589
  • Fax:
Mailing address:
  • Phone: 808-205-4977
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number6048
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number27624
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: