Provider Demographics
NPI:1134519549
Name:OBANDO, DAVID MARTIN (ANMT, LMT)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:MARTIN
Last Name:OBANDO
Suffix:
Gender:M
Credentials:ANMT, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 83476
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97283-0476
Mailing Address - Country:US
Mailing Address - Phone:541-286-5268
Mailing Address - Fax:
Practice Address - Street 1:230 SW 3RD ST
Practice Address - Street 2:SUITE 212
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97333-4692
Practice Address - Country:US
Practice Address - Phone:541-286-5268
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-23
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR19202225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist