Healthcare Provider Details

I. General information

NPI: 1053561506
Provider Name (Legal Business Name): WENDY LEE MARSHALL LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2008
Last Update Date: 01/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 WASHINGTON ST. SW 330B
ALBANY OR
97321
US

IV. Provider business mailing address

PO BOX 1265
ALBANY OR
97321-0540
US

V. Phone/Fax

Practice location:
  • Phone: 541-979-0000
  • Fax:
Mailing address:
  • Phone: 541-979-0000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number6951
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: