Individual
MS. MARTIE M COBLENTZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
27725 JAHN RD, GRAND RONDE, OR 97347-9735
(503) 510-9110
(503) 879-5931
Mailing address
27725 JAHN RD, GRAND RONDE, OR 97347-9735
(503) 510-9110
(503) 879-5931
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
MAQ00021059
WA
171W00000X
Contractor
Primary
OR 12030
OR
Other
Enumeration date
05/11/2008
Last updated
05/11/2008
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