Provider Demographics
NPI:1386822906
Name:MARIOTTI, JENNA MARIE (LMP)
Entity Type:Individual
Prefix:MS
First Name:JENNA
Middle Name:MARIE
Last Name:MARIOTTI
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:MRS
Other - First Name:JENNA
Other - Middle Name:MARIE
Other - Last Name:ODNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMP
Mailing Address - Street 1:2310 MILDRED ST W
Mailing Address - Street 2:SUITE 130
Mailing Address - City:UNIVERSITY PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:98466-6036
Mailing Address - Country:US
Mailing Address - Phone:253-460-4244
Mailing Address - Fax:
Practice Address - Street 1:2310 MILDRED ST W
Practice Address - Street 2:SUITE 130
Practice Address - City:UNIVERSITY PLACE
Practice Address - State:WA
Practice Address - Zip Code:98466-6036
Practice Address - Country:US
Practice Address - Phone:253-460-4244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-06
Last Update Date:2015-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA000019244225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist