Healthcare Provider Details

I. General information

NPI: 1952661860
Provider Name (Legal Business Name): STEPHANIE M MARTIN LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2012
Last Update Date: 05/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6066 HIGHWAY 291
NINE MILE FALLS WA
99026-5008
US

IV. Provider business mailing address

PO BOX 549
NINE MILE FALLS WA
99026-0549
US

V. Phone/Fax

Practice location:
  • Phone: 509-465-5663
  • Fax: 509-467-0760
Mailing address:
  • Phone: 509-465-5663
  • Fax: 509-467-8663

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberNC10061752
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: