Provider Demographics
NPI:1982973673
Name:MARTIN, ADRIANE MERYL
Entity Type:Individual
Prefix:
First Name:ADRIANE
Middle Name:MERYL
Last Name:MARTIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ADRIANE
Other - Middle Name:MERYL
Other - Last Name:BOYLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16030 BOTHELL EVERETT HWY
Mailing Address - Street 2:STE 220
Mailing Address - City:MILL CREEK
Mailing Address - State:WA
Mailing Address - Zip Code:98012-1741
Mailing Address - Country:US
Mailing Address - Phone:425-385-3060
Mailing Address - Fax:425-385-2230
Practice Address - Street 1:16030 BOTHELL EVERETT HWY
Practice Address - Street 2:STE 220
Practice Address - City:MILL CREEK
Practice Address - State:WA
Practice Address - Zip Code:98012-1741
Practice Address - Country:US
Practice Address - Phone:425-385-3060
Practice Address - Fax:425-385-2230
Is Sole Proprietor?:No
Enumeration Date:2011-12-25
Last Update Date:2011-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60042292225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist