Healthcare Provider Details

I. General information

NPI: 1598351751
Provider Name (Legal Business Name): MARGOT MILES CHT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2020
Last Update Date: 12/11/2020
Certification Date: 12/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15110 BOONES FERRY RD STE 300D
LAKE OSWEGO OR
97035-3460
US

IV. Provider business mailing address

15110 BOONES FERRY RD STE 300D
LAKE OSWEGO OR
97035-3460
US

V. Phone/Fax

Practice location:
  • Phone: 503-442-6221
  • Fax:
Mailing address:
  • Phone: 503-442-6221
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: