Healthcare Provider Details

I. General information

NPI: 1790791630
Provider Name (Legal Business Name): ELISHA MILLER OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 SW DENNIS AVE
HILLSBORO OR
97123-3928
US

IV. Provider business mailing address

403 SW DENNIS AVE
HILLSBORO OR
97123-3928
US

V. Phone/Fax

Practice location:
  • Phone: 503-640-3803
  • Fax: 503-640-3805
Mailing address:
  • Phone: 503-640-3803
  • Fax: 503-640-3805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number1066784
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: