Provider Demographics
NPI:1497162861
Name:MARTIN, ROBIN NASH (LMT#19793)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:NASH
Last Name:MARTIN
Suffix:
Gender:F
Credentials:LMT#19793
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3404 3RD AVE SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-4600
Mailing Address - Country:US
Mailing Address - Phone:541-350-2109
Mailing Address - Fax:
Practice Address - Street 1:3404 3RD AVE SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-4600
Practice Address - Country:US
Practice Address - Phone:541-350-2109
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-17
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR19793225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist