Healthcare Provider Details

I. General information

NPI: 1275184251
Provider Name (Legal Business Name): MARFA OVCHINNIKOV
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2019
Last Update Date: 01/31/2022
Certification Date: 01/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 N MOLALLLA AVE
MOLALLA OR
97038
US

IV. Provider business mailing address

32850 S MORCOM ST
WOODBURN OR
97071-8783
US

V. Phone/Fax

Practice location:
  • Phone: 971-701-0531
  • Fax:
Mailing address:
  • Phone: 971-701-0531
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number22746
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: