MEDICARE: ROBIN NASH MARTIN LMT#19793

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	19793	OR

General Provider Information

NPI Number	:	1497162861
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBIN NASH MARTIN LMT#19793

Provider Business Mailing Address
First Line	:	3404 3RD AVE SE
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97302-4600
Country	:	US
Telephone Number	:	541-350-2109
Fax Number	:

Provider Business Practice Location Address
First Line	:	3404 3RD AVE SE
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97302-4600
Country	:	US
Telephone Number	:	541-350-2109
Fax Number	:

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

Provider Enumeration Date	:	07/17/2014
Last Update Date	:	07/17/2014

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