Provider Demographics
NPI:1154652808
Name:MAINS, MARI ANN (LMT)
Entity Type:Individual
Prefix:MISS
First Name:MARI
Middle Name:ANN
Last Name:MAINS
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 1:8366 SE CAUSEY AVE APT 248
Mailing Address - Street 2:
Mailing Address - City:HAPPY VALLEY
Mailing Address - State:OR
Mailing Address - Zip Code:97086-7654
Mailing Address - Country:US
Mailing Address - Phone:503-880-8216
Mailing Address - Fax:
Practice Address - Street 1:14605 SE 202ND AVE
Practice Address - Street 2:
Practice Address - City:DAMASCUS
Practice Address - State:OR
Practice Address - Zip Code:97089-7718
Practice Address - Country:US
Practice Address - Phone:503-658-2225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-20
Last Update Date:2010-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR15614225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist