Provider Demographics
NPI:1477761674
Name:MARCHENKO, OLEKSANDR A (LMP)
Entity Type:Individual
Prefix:MR
First Name:OLEKSANDR
Middle Name:A
Last Name:MARCHENKO
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10638 SE 254TH PL
Mailing Address - Street 2:APT.# B301
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98030-6416
Mailing Address - Country:US
Mailing Address - Phone:253-854-2743
Mailing Address - Fax:206-361-0636
Practice Address - Street 1:10638 SE 254TH PL
Practice Address - Street 2:APT.# B301
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98030-6416
Practice Address - Country:US
Practice Address - Phone:253-854-2743
Practice Address - Fax:206-361-0636
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00022322225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist