Provider Demographics
NPI:1821346446
Name:NILES, EMILY AMARYLLIS (LMP)
Entity Type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:AMARYLLIS
Last Name:NILES
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:PO BOX 1601
Mailing Address - Street 2:
Mailing Address - City:STANWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98292-1601
Mailing Address - Country:US
Mailing Address - Phone:425-418-0591
Mailing Address - Fax:
Practice Address - Street 1:16311 70TH AVE NW
Practice Address - Street 2:
Practice Address - City:STANWOOD
Practice Address - State:WA
Practice Address - Zip Code:98292-6900
Practice Address - Country:US
Practice Address - Phone:425-418-0591
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-29
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60293257225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist