Provider Demographics
NPI:1467830075
Name:MAREI, BASSEM (LMT)
Entity Type:Individual
Prefix:
First Name:BASSEM
Middle Name:
Last Name:MAREI
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3198 SW 178TH AVE
Mailing Address - Street 2:MAREI
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97003-4419
Mailing Address - Country:US
Mailing Address - Phone:503-327-5527
Mailing Address - Fax:
Practice Address - Street 1:3198 SW 178TH AVE
Practice Address - Street 2:MAREI
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97003-4419
Practice Address - Country:US
Practice Address - Phone:503-327-5527
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-14
Last Update Date:2015-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171W00000X
OR18111173C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173C00000XOther Service ProvidersReflexologist
No171W00000XOther Service ProvidersContractor