Provider Demographics
NPI:1558493734
Name:WELTON, MARTI P (LMP)
Entity Type:Individual
Prefix:MS
First Name:MARTI
Middle Name:P
Last Name:WELTON
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:MS
Other - First Name:MARTI
Other - Middle Name:P
Other - Last Name:REARDON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMP
Mailing Address - Street 1:PO BOX 1282
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98206-1282
Mailing Address - Country:US
Mailing Address - Phone:425-293-3194
Mailing Address - Fax:425-774-3651
Practice Address - Street 1:2920 RUCKER AVE
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-3930
Practice Address - Country:US
Practice Address - Phone:425-293-3194
Practice Address - Fax:425-774-3651
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00012246174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist