Healthcare Provider Details

I. General information

NPI: 1528235983
Provider Name (Legal Business Name): SARA L. BOAZ LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SARA L. VAIL LMT

II. Dates (important events)

Enumeration Date: 05/14/2008
Last Update Date: 10/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30789 SW BOONES FERRY RD STE P
WILSONVILLE OR
97070-7842
US

IV. Provider business mailing address

30789 SW BOONES FERRY RD STE P
WILSONVILLE OR
97070-7842
US

V. Phone/Fax

Practice location:
  • Phone: 503-682-6778
  • Fax: 503-682-6744
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number7115
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: