Provider Demographics
NPI:1083850309
Name:MILLER, KATHRYN JANE (LAC)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:JANE
Last Name:MILLER
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:KATE
Other - Middle Name:JANE
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LAC
Mailing Address - Street 1:506 SW 6TH AVE STE 801
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97204-1521
Mailing Address - Country:US
Mailing Address - Phone:503-241-6505
Mailing Address - Fax:
Practice Address - Street 1:506 SW 6TH AVE STE 801
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97204-1521
Practice Address - Country:US
Practice Address - Phone:503-241-6505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-17
Last Update Date:2008-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC01235171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist