Provider Demographics
NPI:1679620660
Name:CLEM, AMY TURNER (LMP)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:TURNER
Last Name:CLEM
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15828 LOBSTER VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:ALSEA
Mailing Address - State:OR
Mailing Address - Zip Code:97324-9439
Mailing Address - Country:US
Mailing Address - Phone:206-371-6936
Mailing Address - Fax:
Practice Address - Street 1:929 NW GRANT AVE
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-4503
Practice Address - Country:US
Practice Address - Phone:206-371-6936
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00017378225700000X
OR23259225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist