Healthcare Provider Details

I. General information

NPI: 1114337730
Provider Name (Legal Business Name): MARTHA BLANCHET L.M.T., M.A., C.H.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2014
Last Update Date: 05/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2905 ADAMS ST
EUGENE OR
97405-2373
US

IV. Provider business mailing address

2905 ADAMS ST
EUGENE OR
97405-2373
US

V. Phone/Fax

Practice location:
  • Phone: 541-915-8649
  • Fax:
Mailing address:
  • Phone: 541-915-8649
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number3724
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: