Healthcare Provider Details

I. General information

NPI: 1497196182
Provider Name (Legal Business Name): MISS MOLLIJOY ARLENE BOERSEMA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2013
Last Update Date: 07/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2809 MERIDIAN AVE E
EDGEWOOD WA
98371-2108
US

IV. Provider business mailing address

2809 MERIDIAN AVE E
EDGEWOOD WA
98371-2108
US

V. Phone/Fax

Practice location:
  • Phone: 253-840-1100
  • Fax:
Mailing address:
  • Phone: 253-232-3227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA 60332278
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: