Provider Demographics
NPI:1073843116
Name:STARR, MARLIN DOUGLAS (LMT)
Entity type:Individual
Prefix:MR
First Name:MARLIN
Middle Name:DOUGLAS
Last Name:STARR
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:913 S. BEECH ST
Mailing Address - Street 2:
Mailing Address - City:CORNELIUS
Mailing Address - State:OR
Mailing Address - Zip Code:97113
Mailing Address - Country:US
Mailing Address - Phone:503-791-2394
Mailing Address - Fax:
Practice Address - Street 1:7689 SW CAPITOL HWY
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219-2475
Practice Address - Country:US
Practice Address - Phone:503-445-4433
Practice Address - Fax:503-445-4464
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-13
Last Update Date:2011-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR16178225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist