Basic Information
| Provider Information | |||||||||
| NPI: | 1609193275 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JAVIER | ||||||||
| FirstName: | MARTILENNY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | PTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8361 MADISON AVE | ||||||||
| Address2: | |||||||||
| City: | FT LEWIS | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984331320 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9102869529 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 6220 S ALASKA ST | ||||||||
| Address2: | |||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984081317 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2534765300 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/22/2010 | ||||||||
| LastUpdateDate: | 04/22/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 172V00000X | P160135007 | WA | Y | Other Service Providers | Community Health Worker |
No ID Information.