Provider Demographics
NPI:1114337730
Name:BLANCHET, MARTHA (LMT, MA, CHP)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:
Last Name:BLANCHET
Suffix:
Gender:F
Credentials:LMT, MA, CHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2905 ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-2373
Mailing Address - Country:US
Mailing Address - Phone:541-915-8649
Mailing Address - Fax:
Practice Address - Street 1:2905 ADAMS ST
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97405-2373
Practice Address - Country:US
Practice Address - Phone:541-915-8649
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-05
Last Update Date:2014-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225000000X
OR3724225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter