Provider Demographics
NPI:1710019211
Name:MARTELL, CASEY (ND)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:
Last Name:MARTELL
Suffix:
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2507 NW ARNOTT LN
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97229-1171
Mailing Address - Country:US
Mailing Address - Phone:503-888-1044
Mailing Address - Fax:503-715-2070
Practice Address - Street 1:2507 NW ARNOTT LN
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97229-1171
Practice Address - Country:US
Practice Address - Phone:503-888-1044
Practice Address - Fax:503-715-2070
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-10
Last Update Date:2019-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ12-1319175F00000X
OR1002175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath