Provider Demographics
NPI:1902392343
Name:BOKSA, MAUREEN (LMT)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:
Last Name:BOKSA
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1399 MILL POND RD
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-7321
Mailing Address - Country:US
Mailing Address - Phone:808-264-2072
Mailing Address - Fax:
Practice Address - Street 1:258 A ST STE 21
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-1947
Practice Address - Country:US
Practice Address - Phone:541-301-7040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-09
Last Update Date:2018-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI14101225700000X
OR22044225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist