Provider Demographics
NPI:1245489202
Name:MARSH, TABITHA A (DACM)
Entity type:Individual
Prefix:
First Name:TABITHA
Middle Name:A
Last Name:MARSH
Suffix:
Gender:F
Credentials:DACM
Other - Prefix:
Other - First Name:TABITHA
Other - Middle Name:A
Other - Last Name:COLLINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT, LAC
Mailing Address - Street 1:820 NW WALLACE RD
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97128-5312
Mailing Address - Country:US
Mailing Address - Phone:503-515-9626
Mailing Address - Fax:
Practice Address - Street 1:5305 RIVER RD N STE B
Practice Address - Street 2:
Practice Address - City:KEIZER
Practice Address - State:OR
Practice Address - Zip Code:97303-5324
Practice Address - Country:US
Practice Address - Phone:503-515-9626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-15
Last Update Date:2021-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5104225700000X
ORAC160117171100000X, 171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist