Healthcare Provider Details

I. General information

NPI: 1447581665
Provider Name (Legal Business Name): TAMMY M MARR LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2010
Last Update Date: 06/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

341 N. 4TH AVE W.
MIDDLETON ID
83644
US

IV. Provider business mailing address

P.O. BOX 53
MIDDLETON ID
83644
US

V. Phone/Fax

Practice location:
  • Phone: 208-703-1098
  • Fax:
Mailing address:
  • Phone: 208-703-1098
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225500000X
TaxonomyRespiratory/Developmental/Rehabilitative Specialist/Technologist
License NumberMASG-91
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: