Healthcare Provider Details

I. General information

NPI: 1780592584
Provider Name (Legal Business Name): MARLEE BLUE
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

6126 NE BOTHELL WAY FL 2
KENMORE WA
98028-8939
US

IV. Provider business mailing address

6126 NE BOTHELL WAY FL 2
KENMORE WA
98028-8939
US

V. Phone/Fax

Practice location:
  • Phone: 206-617-1337
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMASS.MA.70171767
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: