Provider Demographics
NPI:1265644884
Name:MARTIN, TERRI J (LMT)
Entity Type:Individual
Prefix:
First Name:TERRI
Middle Name:J
Last Name:MARTIN
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 1:15661 SE 82ND DRIVE
Mailing Address - Street 2:
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97015
Mailing Address - Country:US
Mailing Address - Phone:503-343-9851
Mailing Address - Fax:503-376-6036
Practice Address - Street 1:15661 SE 82ND DRIVE
Practice Address - Street 2:
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015
Practice Address - Country:US
Practice Address - Phone:503-343-9851
Practice Address - Fax:503-376-6036
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR7406174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist