Provider Demographics
NPI:1184196362
Name:ROBINSON, MARLANA (LMT MMP)
Entity Type:Individual
Prefix:
First Name:MARLANA
Middle Name:
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:LMT MMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 N BROADWAY AVE STE 10
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:OK
Mailing Address - Zip Code:74820-5052
Mailing Address - Country:US
Mailing Address - Phone:580-279-4463
Mailing Address - Fax:
Practice Address - Street 1:119 N BROADWAY AVE STE 10
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820-5052
Practice Address - Country:US
Practice Address - Phone:580-279-4463
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-27
Last Update Date:2018-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK173076225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty