Healthcare Provider Details

I. General information

NPI: 1245489202
Provider Name (Legal Business Name): TABITHA A. MARSH DACM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TABITHA A. COLLINS LMT, LAC

II. Dates (important events)

Enumeration Date: 09/15/2008
Last Update Date: 11/26/2021
Certification Date: 11/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5305 RIVER RD N STE B
KEIZER OR
97303-5324
US

IV. Provider business mailing address

820 NW WALLACE RD
MCMINNVILLE OR
97128-5312
US

V. Phone/Fax

Practice location:
  • Phone: 503-515-9626
  • Fax:
Mailing address:
  • Phone: 503-515-9626
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number5104
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC160117
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: