Healthcare Provider Details

I. General information

NPI: 1285862995
Provider Name (Legal Business Name): ELIZABETH MARIE MILLER OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELIZABETH MARIE WELLE OT

II. Dates (important events)

Enumeration Date: 07/01/2009
Last Update Date: 08/11/2025
Certification Date: 08/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7305 SE CIRCUIT DR STE 140
HILLSBORO OR
97123-1961
US

IV. Provider business mailing address

PO BOX 31001-4180
PASADENA CA
91110-4180
US

V. Phone/Fax

Practice location:
  • Phone: 971-501-4905
  • Fax:
Mailing address:
  • Phone: 503-215-6494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number252484
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: