MEDICARE: MRS. TERRY ANN R DAMO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	MAT8894	HI

General Provider Information

NPI Number	:	1295850782
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TERRY ANN R DAMO

Provider Business Mailing Address
First Line	:	99-128 AIEA HEIGHTS DR STE 207
Second Line	:
City	:	AIEA
State	:	HI
Zip	:	96701-3968
Country	:	US
Telephone Number	:	808-487-0487
Fax Number	:

Provider Business Practice Location Address
First Line	:	99-128 AIEA HEIGHTS DR STE 207
Second Line	:
City	:	AIEA
State	:	HI
Zip	:	96701-3968
Country	:	US
Telephone Number	:	808-487-0487
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/21/2007
Last Update Date	:	12/13/2017

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