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General NPI Number Information
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NPI Number | 1477917300
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Entity Type | Organization
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Legal Business Name | BOBBIE DAMERON
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Dates
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Enumeration Date | 04/06/2016
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Last Update Date | 04/06/2016
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Provider Practice Location Address
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Address Line | 145 TRADD ST
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City | SPARTANBURG
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State | SC
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Zip | 29301-5085
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Country | US
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Telephone | 864-804-6395
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Fax |
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Provider Business Mailing Address
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Address Line | 8 N ORCHARD FARMS AVE
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City | SIMPSONVILLE
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State | SC
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Zip | 29681-4866
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Country | US
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Telephone | 501-205-9463
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Fax |
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Authorized Official
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Title or Position | MASSAGE THERAPIST
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Name | BOBBIE G DAMERON
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Credential |
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Telephone | 501-205-9463
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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 | 9588
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License Number State | SC
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