Healthcare Provider Details

I. General information

NPI: 1457600900
Provider Name (Legal Business Name): KATIE L MILES LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATIE L MILES LMT

II. Dates (important events)

Enumeration Date: 08/30/2012
Last Update Date: 08/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

821 ELM ST SW
ALBANY OR
97321
US

IV. Provider business mailing address

821 ELM ST SW
ALBANY OR
97321
US

V. Phone/Fax

Practice location:
  • Phone: 541-928-5590
  • Fax: 541-924-9943
Mailing address:
  • Phone: 541-928-5590
  • Fax: 541-924-9943

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number18304
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: