Provider Demographics
NPI:1407270036
Name:BOARDWAY, EMILY
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:BOARDWAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1503 14TH AVE S
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98144-3411
Mailing Address - Country:US
Mailing Address - Phone:253-226-5561
Mailing Address - Fax:
Practice Address - Street 1:3417 EVANSTON AVE N
Practice Address - Street 2:418
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-8626
Practice Address - Country:US
Practice Address - Phone:253-226-5561
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-18
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60408117225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist