Healthcare Provider Details

I. General information

NPI: 1457867822
Provider Name (Legal Business Name): EMILY JEAN NUGEN MOTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EMILY JEAN RICE NA

II. Dates (important events)

Enumeration Date: 12/21/2017
Last Update Date: 12/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1707 3RD ST SE
PUYALLUP WA
98372-4506
US

IV. Provider business mailing address

102 23RD AVE SW APT C101
PUYALLUP WA
98371-7881
US

V. Phone/Fax

Practice location:
  • Phone: 253-841-3041
  • Fax:
Mailing address:
  • Phone: 253-576-0756
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number60809600
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: