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General NPI Number Information
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NPI Number | 1245845619
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Entity Type | Individual
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Provider Name | ALYSSA MICHELLE MILES LMT
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Gender | Female
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Dates
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Enumeration Date | 09/12/2020
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Last Update Date | 10/26/2021
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Provider Practice Location Address
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Address Line | 1900 BROADWAY AVE TRLR 1
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City | HOQUIAM
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State | WA
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Zip | 98550-1148
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Country | US
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Telephone | 360-593-6581
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Fax |
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Provider Business Mailing Address
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Address Line | 31004 MILITARY RD S
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City | AUBURN
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State | WA
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Zip | 98001-3218
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Country | US
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Telephone | 360-593-6581
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MA60886394
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License Number State | WA
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