Provider Demographics
NPI:1396046140
Name:PAYNE, EMILY EMETT (LMP)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:EMETT
Last Name:PAYNE
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5419 S 336TH ST
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98001-9718
Mailing Address - Country:US
Mailing Address - Phone:206-409-0270
Mailing Address - Fax:
Practice Address - Street 1:6716 EASTSIDE DR NE
Practice Address - Street 2:#6
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98422-1147
Practice Address - Country:US
Practice Address - Phone:206-409-0270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-10
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60191846174400000X, 225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No174400000XOther Service ProvidersSpecialist