Provider Demographics
NPI:1336260991
Name:PREUSS, EMMA PATRICIA (LPTA)
Entity Type:Individual
Prefix:
First Name:EMMA
Middle Name:PATRICIA
Last Name:PREUSS
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 BEAUVAIS RD
Mailing Address - Street 2:
Mailing Address - City:KELSO
Mailing Address - State:WA
Mailing Address - Zip Code:98626-9734
Mailing Address - Country:US
Mailing Address - Phone:503-407-3550
Mailing Address - Fax:
Practice Address - Street 1:115 BEAUVAIS RD
Practice Address - Street 2:
Practice Address - City:KELSO
Practice Address - State:WA
Practice Address - Zip Code:98626-9734
Practice Address - Country:US
Practice Address - Phone:503-407-3550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA9349174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist