Healthcare Provider Details

I. General information

NPI: 1124120332
Provider Name (Legal Business Name): MARINA ALENE MARTIN LMP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9812 205TH AVE E STE C
BONNEY LAKE WA
98391-8382
US

IV. Provider business mailing address

44932 283RD AVE SE
ENUMCLAW WA
98022-9207
US

V. Phone/Fax

Practice location:
  • Phone: 253-863-6378
  • Fax:
Mailing address:
  • Phone: 206-458-0955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA00018754
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: