Provider Demographics
NPI:1497196182
Name:BOERSEMA, MOLLIJOY ARLENE
Entity Type:Individual
Prefix:MISS
First Name:MOLLIJOY
Middle Name:ARLENE
Last Name:BOERSEMA
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 1:2809 MERIDIAN AVE E
Mailing Address - Street 2:
Mailing Address - City:EDGEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98371-2108
Mailing Address - Country:US
Mailing Address - Phone:253-232-3227
Mailing Address - Fax:
Practice Address - Street 1:2809 MERIDIAN AVE E
Practice Address - Street 2:
Practice Address - City:EDGEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98371-2108
Practice Address - Country:US
Practice Address - Phone:253-840-1100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-10
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60332278225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist