Provider Demographics
NPI:1285781419
Name:OVEREN, MARINA L (LMP)
Entity type:Individual
Prefix:MISS
First Name:MARINA
Middle Name:L
Last Name:OVEREN
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:PO BOX 221
Mailing Address - Street 2:
Mailing Address - City:CHENEY
Mailing Address - State:WA
Mailing Address - Zip Code:99004-0221
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7527 N MARKET ST
Practice Address - Street 2:B #1
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99217-7828
Practice Address - Country:US
Practice Address - Phone:509-467-8814
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00015258225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist