Provider Demographics
NPI:1831360429
Name:MARRETT, CANDIS LYNN (LMP)
Entity type:Individual
Prefix:MRS
First Name:CANDIS
Middle Name:LYNN
Last Name:MARRETT
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:MS
Other - First Name:CANDIS
Other - Middle Name:LYNN
Other - Last Name:CONLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMP
Mailing Address - Street 1:21 CEDAR HILL LN
Mailing Address - Street 2:SE
Mailing Address - City:SEQUIM
Mailing Address - State:WA
Mailing Address - Zip Code:98382-8893
Mailing Address - Country:US
Mailing Address - Phone:360-460-5870
Mailing Address - Fax:
Practice Address - Street 1:21 CEDAR HILL LN
Practice Address - Street 2:
Practice Address - City:SEQUIM
Practice Address - State:WA
Practice Address - Zip Code:98382-8893
Practice Address - Country:US
Practice Address - Phone:360-460-5870
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-21
Last Update Date:2019-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00024664225700000X
WAMA000246225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist