Provider Demographics
NPI:1891209854
Name:HALE, MARTA LUCIA MARIE (RT)
Entity Type:Individual
Prefix:
First Name:MARTA
Middle Name:LUCIA MARIE
Last Name:HALE
Suffix:
Gender:F
Credentials:RT
Other - Prefix:
Other - First Name:MARTA
Other - Middle Name:LUCIA MARIE
Other - Last Name:HALE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RT
Mailing Address - Street 1:93 N 285 E
Mailing Address - Street 2:
Mailing Address - City:BLACKFOOT
Mailing Address - State:ID
Mailing Address - Zip Code:83221-5987
Mailing Address - Country:US
Mailing Address - Phone:208-705-5497
Mailing Address - Fax:
Practice Address - Street 1:2001 S WOODRUFF AVE STE B
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-6374
Practice Address - Country:US
Practice Address - Phone:208-529-2498
Practice Address - Fax:208-528-7971
Is Sole Proprietor?:No
Enumeration Date:2017-11-28
Last Update Date:2017-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2278P1006XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedPulmonary Function Technologist