Provider Demographics
NPI:1679829147
Name:MARSHALL, ERICA CHENELLE (LMT)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:CHENELLE
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MRS
Other - First Name:ERICA
Other - Middle Name:CHENELLE
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1136 DONALD AVE
Mailing Address - Street 2:
Mailing Address - City:OAK HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98277-8228
Mailing Address - Country:US
Mailing Address - Phone:541-761-7698
Mailing Address - Fax:
Practice Address - Street 1:31955 SR 20
Practice Address - Street 2:
Practice Address - City:OAK HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98277
Practice Address - Country:US
Practice Address - Phone:360-679-8600
Practice Address - Fax:360-679-8554
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-01
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR17625225700000X
WA61029009225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist