Provider Demographics
NPI:1336596618
Name:MARTIN, WENDY ANN (LMT)
Entity Type:Individual
Prefix:MS
First Name:WENDY
Middle Name:ANN
Last Name:MARTIN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:WENDY
Other - Middle Name:ANN MARTIN
Other - Last Name:MARIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1034 LAWRENCE ST.
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401
Mailing Address - Country:US
Mailing Address - Phone:541-227-1810
Mailing Address - Fax:541-304-2211
Practice Address - Street 1:1034 LAWRENCE ST.
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401
Practice Address - Country:US
Practice Address - Phone:541-227-1810
Practice Address - Fax:541-304-2211
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-17
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR21809225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist