Provider Demographics
NPI:1790997757
Name:BRANDT, MARLA SUSAN (LMP)
Entity Type:Individual
Prefix:MS
First Name:MARLA
Middle Name:SUSAN
Last Name:BRANDT
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:MS
Other - First Name:MARLA
Other - Middle Name:SUSAN
Other - Last Name:BRANDT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMP
Mailing Address - Street 1:3220 NW 69TH ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98117-6127
Mailing Address - Country:US
Mailing Address - Phone:206-782-8381
Mailing Address - Fax:
Practice Address - Street 1:307 BELL ST STE 102
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98020-3216
Practice Address - Country:US
Practice Address - Phone:425-771-1751
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00003245225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist