MEDICARE: BRANDON MARTIN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	19880	OR

General Provider Information

NPI Number	:	1164137873
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRANDON MARTIN

Provider Business Mailing Address
First Line	:	26160 SW CANYON CREEK RD APT 303
Second Line	:
City	:	WILSONVILLE
State	:	OR
Zip	:	97070-8661
Country	:	US
Telephone Number	:	503-460-7356
Fax Number	:

Provider Business Practice Location Address
First Line	:	4050 FAIRVIEW INDUSTRIAL DR SE
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97302-1005
Country	:	US
Telephone Number	:	503-460-7356
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/17/2023
Last Update Date	:	11/01/2024

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Directions to “ BRANDON MARTIN ” Practice Location

Language	Start Address	Practice Location

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