MEDICARE: AMY DEMARCO-GREENHALGH THW

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	175T00000X	Peer Specialist	115833	OR

General Provider Information

NPI Number	:	1497614937
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY DEMARCO-GREENHALGH THW

Provider Business Mailing Address
First Line	:	3484 GLEN CREEK RD NW
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97304-2248
Country	:	US
Telephone Number	:	916-849-5221
Fax Number	:

Provider Business Practice Location Address
First Line	:	4263 COMMERCIAL ST SE
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97302-3995
Country	:	US
Telephone Number	:	503-363-8068
Fax Number	:

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

Provider Enumeration Date	:	01/20/2026
Last Update Date	:	01/20/2026

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