Provider Demographics
NPI:1093015570
Name:MILHAUSER, NICOLE D (OT)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:D
Last Name:MILHAUSER
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4902 SW SLAVIN RD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-2801
Mailing Address - Country:US
Mailing Address - Phone:815-822-4592
Mailing Address - Fax:
Practice Address - Street 1:1600 3RD AVE
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-3231
Practice Address - Country:US
Practice Address - Phone:360-425-9810
Practice Address - Fax:360-425-1053
Is Sole Proprietor?:No
Enumeration Date:2010-10-29
Last Update Date:2010-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT60189012174400000X
OR274950174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist