Provider Demographics
NPI:1457867822
Name:NUGEN, EMILY JEAN (MOTR/L)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:JEAN
Last Name:NUGEN
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:JEAN
Other - Last Name:RICE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NA
Mailing Address - Street 1:102 23RD AVE SW APT C101
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98371-7881
Mailing Address - Country:US
Mailing Address - Phone:253-576-0756
Mailing Address - Fax:
Practice Address - Street 1:1707 3RD ST SE
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372-4506
Practice Address - Country:US
Practice Address - Phone:253-841-3041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-21
Last Update Date:2017-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60809600225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist