Provider Demographics
NPI:1003259623
Name:HACKBARTH, MARNIE L (LMT)
Entity Type:Individual
Prefix:MS
First Name:MARNIE
Middle Name:L
Last Name:HACKBARTH
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:895 COUNTRY CLUB RD
Mailing Address - Street 2:SUITE A140
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-6003
Mailing Address - Country:US
Mailing Address - Phone:541-484-3055
Mailing Address - Fax:
Practice Address - Street 1:895 COUNTRY CLUB RD
Practice Address - Street 2:SUITE A140
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-6003
Practice Address - Country:US
Practice Address - Phone:541-484-3055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-12
Last Update Date:2016-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR16324174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist