Healthcare Provider Details

I. General information

NPI: 1538435946
Provider Name (Legal Business Name): KATHLEEN M MILLER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2012
Last Update Date: 03/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

460 COBURG RD STE 306
EUGENE OR
97401-5531
US

IV. Provider business mailing address

1035 SE BELL AVE
CORVALLIS OR
97333-2055
US

V. Phone/Fax

Practice location:
  • Phone: 541-334-5000
  • Fax:
Mailing address:
  • Phone: 541-207-7304
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number15606
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: