Provider Demographics
NPI:1497415954
Name:HAWKINS, MARLEY MARINA (LMT)
Entity Type:Individual
Prefix:
First Name:MARLEY
Middle Name:MARINA
Last Name:HAWKINS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7435 MOUNT SHERMAN RD
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80503-8678
Mailing Address - Country:US
Mailing Address - Phone:815-761-8566
Mailing Address - Fax:
Practice Address - Street 1:2515 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-4110
Practice Address - Country:US
Practice Address - Phone:720-509-9588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-26
Last Update Date:2021-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT.0023467225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist