Provider Demographics
NPI:1184995722
Name:BOJANG, MONIQUE COLETTA (L M P)
Entity type:Individual
Prefix:
First Name:MONIQUE
Middle Name:COLETTA
Last Name:BOJANG
Suffix:
Gender:F
Credentials:L M P
Other - Prefix:
Other - First Name:MONIQUE
Other - Middle Name:COLETTA
Other - Last Name:CALHOUN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:L M P
Mailing Address - Street 1:23114 136TH PL SE
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98042-3224
Mailing Address - Country:US
Mailing Address - Phone:206-369-0983
Mailing Address - Fax:
Practice Address - Street 1:23229 PACIFIC HWY S
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98032-2721
Practice Address - Country:US
Practice Address - Phone:206-824-6968
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-12
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00015340225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist