Provider Demographics
NPI:1144609363
Name:BOUDWIN, EMILY (NMT, LMT)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:BOUDWIN
Suffix:
Gender:F
Credentials:NMT, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 S ORCHARD ST
Mailing Address - Street 2:SUITE 224
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83705-1966
Mailing Address - Country:US
Mailing Address - Phone:208-820-1942
Mailing Address - Fax:
Practice Address - Street 1:1111 S ORCHARD ST
Practice Address - Street 2:SUITE 224
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83705-1966
Practice Address - Country:US
Practice Address - Phone:208-820-1942
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-20
Last Update Date:2015-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDMASG-61225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist