1568607349 NPI number — ARLENE E MARTIN LMP

Table of content: ARLENE E MARTIN LMP (NPI 1568607349)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568607349 NPI number — ARLENE E MARTIN LMP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARTIN
Provider First Name:
ARLENE
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LMP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1568607349
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/09/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
30013 196TH AVE SE
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
KENT
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98042-9212
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-396-1467
Provider Business Mailing Address Fax Number:
253-638-0761

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
30013 196TH AVE SE
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
KENT
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98042-9212
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-396-1467
Provider Business Practice Location Address Fax Number:
253-638-0761
Provider Enumeration Date:
12/09/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225700000X , with the licence number:  MA00018433 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: MA 00018433 . This is a "WA STATE MASSAGE LICENSE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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