Provider Demographics
NPI:1437999224
Name:PARKER-IRISH, MARINA
Entity type:Individual
Prefix:
First Name:MARINA
Middle Name:
Last Name:PARKER-IRISH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARINA
Other - Middle Name:
Other - Last Name:PARKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12503 MOUNT BELFORD WAY
Mailing Address - Street 2:
Mailing Address - City:PEYTON
Mailing Address - State:CO
Mailing Address - Zip Code:80831-4438
Mailing Address - Country:US
Mailing Address - Phone:719-375-8713
Mailing Address - Fax:
Practice Address - Street 1:12503 MOUNT BELFORD WAY
Practice Address - Street 2:
Practice Address - City:PEYTON
Practice Address - State:CO
Practice Address - Zip Code:80831-4438
Practice Address - Country:US
Practice Address - Phone:719-375-8713
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-29
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0023539225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist