Provider Demographics
NPI:1811603178
Name:RAYNOR, EMMA ELAINE
Entity type:Individual
Prefix:
First Name:EMMA
Middle Name:ELAINE
Last Name:RAYNOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4389 HARBORVIEW DR
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:WA
Mailing Address - Zip Code:98230-9229
Mailing Address - Country:US
Mailing Address - Phone:385-223-0765
Mailing Address - Fax:
Practice Address - Street 1:3800 BYRON AVE STE B10
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98229-2877
Practice Address - Country:US
Practice Address - Phone:385-223-0765
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-30
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61143299225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist