Provider Demographics
NPI:1336217967
Name:BOE, DEBBIE (LMP,CR, NCMMT)
Entity Type:Individual
Prefix:
First Name:DEBBIE
Middle Name:
Last Name:BOE
Suffix:
Gender:F
Credentials:LMP,CR, NCMMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2204 NE 105TH ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98686-8601
Mailing Address - Country:US
Mailing Address - Phone:360-798-4488
Mailing Address - Fax:360-573-2194
Practice Address - Street 1:9106 NE HIGHWAY 99 STE E
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98665-8949
Practice Address - Country:US
Practice Address - Phone:360-798-4488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00014888225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist