Provider Demographics
NPI:1083914402
Name:HARRIS, MICHELE L (LMT)
Entity Type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:L
Last Name:HARRIS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 NW 185TH AVE
Mailing Address - Street 2:#204
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97006-2872
Mailing Address - Country:US
Mailing Address - Phone:503-504-2554
Mailing Address - Fax:
Practice Address - Street 1:9430 SW CORAL ST
Practice Address - Street 2:STE. 203
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-6691
Practice Address - Country:US
Practice Address - Phone:503-504-2554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-01
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR8020174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist