Provider Demographics
NPI:1841619574
Name:MARKS, JAMIE LYNN
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:LYNN
Last Name:MARKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 N COLUMBIA RIVER HWY
Mailing Address - Street 2:SUITE 410
Mailing Address - City:SAINT HELENS
Mailing Address - State:OR
Mailing Address - Zip Code:97051-1299
Mailing Address - Country:US
Mailing Address - Phone:503-410-5623
Mailing Address - Fax:503-410-5672
Practice Address - Street 1:500 N COLUMBIA RIVER HWY
Practice Address - Street 2:SUITE 410
Practice Address - City:SAINT HELENS
Practice Address - State:OR
Practice Address - Zip Code:97051-1299
Practice Address - Country:US
Practice Address - Phone:503-410-5623
Practice Address - Fax:503-410-5672
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-09
Last Update Date:2014-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR11072225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist