Provider Demographics
NPI:1427600428
Name:MARTIN, SPENCER ALLAN (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:
First Name:SPENCER
Middle Name:ALLAN
Last Name:MARTIN
Suffix:
Gender:M
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2704 DELTA OAKS DR
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97408-1740
Mailing Address - Country:US
Mailing Address - Phone:541-484-0360
Mailing Address - Fax:
Practice Address - Street 1:2704 DELTA OAKS DR
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97408-1740
Practice Address - Country:US
Practice Address - Phone:541-484-0360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-10
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR21981225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist