Provider Demographics
NPI:1255545000
Name:BOYCE, MOLLIE ANN (LMP)
Entity type:Individual
Prefix:MS
First Name:MOLLIE
Middle Name:ANN
Last Name:BOYCE
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 1:420 5TH AVE S
Mailing Address - Street 2:STE. 207
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98020-3464
Mailing Address - Country:US
Mailing Address - Phone:206-947-0418
Mailing Address - Fax:
Practice Address - Street 1:420 5TH AVE S
Practice Address - Street 2:STE. 207
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98020-3464
Practice Address - Country:US
Practice Address - Phone:206-947-0418
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00013166225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMA00013166OtherMASSAGE STATE LICENSE