Provider Demographics
NPI:1316266596
Name:FOREMAN, MARLA KAY (RMT)
Entity type:Individual
Prefix:
First Name:MARLA
Middle Name:KAY
Last Name:FOREMAN
Suffix:
Gender:F
Credentials:RMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 MANHATTAN DR
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80303-4254
Mailing Address - Country:US
Mailing Address - Phone:303-919-3892
Mailing Address - Fax:
Practice Address - Street 1:1006 BRAGG PL
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-1801
Practice Address - Country:US
Practice Address - Phone:303-919-3892
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-26
Last Update Date:2011-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5631173C00000X, 225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No173C00000XOther Service ProvidersReflexologist