Healthcare Provider Details

I. General information

NPI: 1982935086
Provider Name (Legal Business Name): KATHLEEN LEILANI MILLER L.M.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2010
Last Update Date: 01/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6250 COMMERCIAL ST SE
SALEM OR
97306-1333
US

IV. Provider business mailing address

2160 UNIVERSITY ST SE
SALEM OR
97302-2104
US

V. Phone/Fax

Practice location:
  • Phone: 503-884-3661
  • Fax:
Mailing address:
  • Phone: 503-884-3661
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code173C00000X
TaxonomyReflexologist
License Number5106
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number5106
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: