Individual
MARTY RAY BOEHLKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
THW
Contact information
Practice address
401 FOURTH ST, FOSSIL, OR 97830-8302
(541) 763-2746
(541) 763-2170
Mailing address
PO BOX 469, HEPPNER, OR 97836-0469
(541) 676-9161
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
11/15/2022
Last updated
11/15/2022
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