Provider Demographics
NPI:1447840129
Name:WALTZ, EMILY (BS)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:WALTZ
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 281
Mailing Address - Street 2:
Mailing Address - City:WALDOBORO
Mailing Address - State:ME
Mailing Address - Zip Code:04572-0281
Mailing Address - Country:US
Mailing Address - Phone:207-975-3151
Mailing Address - Fax:
Practice Address - Street 1:99 MOOSE MEADOW LN
Practice Address - Street 2:
Practice Address - City:WALDOBORO
Practice Address - State:ME
Practice Address - Zip Code:04572
Practice Address - Country:US
Practice Address - Phone:207-975-3151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-26
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist