Provider Demographics
NPI:1053455592
Name:SCARLETT, MARJORIE (LMT)
Entity Type:Individual
Prefix:MS
First Name:MARJORIE
Middle Name:
Last Name:SCARLETT
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 1:4804 N CONCORD AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97217-3609
Mailing Address - Country:US
Mailing Address - Phone:971-258-1088
Mailing Address - Fax:
Practice Address - Street 1:4804 N CONCORD AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97217-3609
Practice Address - Country:US
Practice Address - Phone:971-258-1088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-17
Last Update Date:2015-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR18554225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA200774OtherLABOR & INDUSTRIES ID