Provider Demographics
NPI:1265196018
Name:MARVIN, JESSICA N (LMT)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:N
Last Name:MARVIN
Suffix:
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 1:233 ROGUE RIVER HWY # 1184
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97527-1600
Mailing Address - Country:US
Mailing Address - Phone:541-450-9098
Mailing Address - Fax:
Practice Address - Street 1:836 E MAIN ST STE 3
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-7115
Practice Address - Country:US
Practice Address - Phone:541-450-9098
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-27
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR26549225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist