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General NPI Number Information
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NPI Number | 1134519549
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Entity Type | Individual
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Provider Name | DAVID MARTIN OBANDO ANMT, LMT
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Gender | Male
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Dates
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Enumeration Date | 01/23/2015
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Last Update Date | 01/23/2015
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Provider Practice Location Address
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Address Line | 230 SW 3RD ST SUITE 212
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City | CORVALLIS
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State | OR
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Zip | 97333-4692
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Country | US
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Telephone | 541-286-5268
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 83476
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City | PORTLAND
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State | OR
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Zip | 97283-0476
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Country | US
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Telephone | 541-286-5268
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 19202
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License Number State | OR
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