Healthcare Provider Details

I. General information

NPI: 1356549216
Provider Name (Legal Business Name): HEATHER MARIE ELLER LMP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

603 SE MORRISON RD
VANCOUVER WA
98664-1545
US

IV. Provider business mailing address

10301 SE 147TH AVE
HAPPY VALLEY OR
97236-6061
US

V. Phone/Fax

Practice location:
  • Phone: 503-679-5642
  • Fax:
Mailing address:
  • Phone: 503-679-5642
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172M00000X
TaxonomyMechanotherapist
License NumberMA00016050
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: