Provider Demographics
NPI:1669809075
Name:NORRIS, MARION EILEEN (LMP)
Entity type:Individual
Prefix:
First Name:MARION
Middle Name:EILEEN
Last Name:NORRIS
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4701 NE 72ND AVE
Mailing Address - Street 2:APT. R191
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98661-3602
Mailing Address - Country:US
Mailing Address - Phone:503-894-0262
Mailing Address - Fax:
Practice Address - Street 1:4701 NE 72ND AVE
Practice Address - Street 2:R191
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661-3602
Practice Address - Country:US
Practice Address - Phone:503-894-0262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-30
Last Update Date:2014-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 603766225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist