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General NPI Number Information
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NPI Number | 1669626974
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Entity Type | Individual
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Provider Name | RENAE K MILLER L.M.P.
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Gender | Female
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Dates
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Enumeration Date | 11/13/2008
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Last Update Date | 11/13/2008
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Provider Practice Location Address
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Address Line | 800 SPRAGUE AVE SUITE 102
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City | WALLA WALLA
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State | WA
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Zip | 99362
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Country | US
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Telephone | 509-629-1149
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Fax | 888-508-8357
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Provider Business Mailing Address
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Address Line | 80 NE 15TH AVE
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City | MILTON FREEWATER
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State | OR
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Zip | 97862-1641
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Country | US
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Telephone | 509-629-1149
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Fax | 888-508-8357
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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 | MA00015879
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 5373
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License Number State | OR
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