Provider Demographics
NPI:1386320786
Name:MARTIN, MARIA RENEE (LTA, LE)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:RENEE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:LTA, LE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 E BROADWAY STE 718
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-3159
Mailing Address - Country:US
Mailing Address - Phone:541-543-6868
Mailing Address - Fax:
Practice Address - Street 1:132 E BROADWAY STE 718
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-3159
Practice Address - Country:US
Practice Address - Phone:541-543-6868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-22
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORBAP-TA-101666542255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer