MEDICARE: ALICIA M MIRANDA LMT, COTA (RET)

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	224Z00000X	Occupational Therapy Assistant	OTA 14848	FL
2	225700000X	Massage Therapist	MA41682	FL
3	225700000X	Massage Therapist	24185	OR

General Provider Information

NPI Number	:	1780901959
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALICIA M MIRANDA LMT, COTA (RET)

Provider Business Mailing Address
First Line	:	20070 LARKSPUR LN APT 66
Second Line	:
City	:	WEST LINN
State	:	OR
Zip	:	97068-2381
Country	:	US
Telephone Number	:	727-686-6848
Fax Number	:

Provider Business Practice Location Address
First Line	:	4949 MEADOWS RD STE 140
Second Line	:
City	:	LAKE OSWEGO
State	:	OR
Zip	:	97035-3156
Country	:	US
Telephone Number	:	503-305-7244
Fax Number	:	503-305-8849

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/28/2010
Last Update Date	:	04/27/2025

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