Provider Demographics
NPI:1578092573
Name:MARTENS, JENNIFER RENAE (LMT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:RENAE
Last Name:MARTENS
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 1:446 E MAIN ST STE A
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97123-4187
Mailing Address - Country:US
Mailing Address - Phone:503-992-6731
Mailing Address - Fax:844-231-8879
Practice Address - Street 1:446 E MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-4187
Practice Address - Country:US
Practice Address - Phone:503-970-0764
Practice Address - Fax:844-231-8879
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-05
Last Update Date:2018-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR7348225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty