Provider Demographics
NPI:1912387390
Name:RAVET, MARIETTE I (LMT)
Entity Type:Individual
Prefix:
First Name:MARIETTE
Middle Name:
Last Name:RAVET
Suffix:I
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:696 LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-3123
Mailing Address - Country:US
Mailing Address - Phone:301-221-3511
Mailing Address - Fax:
Practice Address - Street 1:696 LIBERTY ST
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-3123
Practice Address - Country:US
Practice Address - Phone:301-221-3511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-01
Last Update Date:2015-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR17308225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR225700000XOtherMASSAGE THERAPIST