Provider Demographics
NPI:1164735023
Name:MILLER, NAOMI CELESTE (LAC, MAOM)
Entity Type:Individual
Prefix:
First Name:NAOMI
Middle Name:CELESTE
Last Name:MILLER
Suffix:
Gender:F
Credentials:LAC, MAOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 RATCLIFF DR. SE
Mailing Address - Street 2:SUITE 130
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302
Mailing Address - Country:US
Mailing Address - Phone:503-729-8358
Mailing Address - Fax:971-559-5562
Practice Address - Street 1:401 RATCLIFF DR. SE
Practice Address - Street 2:SUITE 130
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302
Practice Address - Country:US
Practice Address - Phone:503-881-8361
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-21
Last Update Date:2017-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC152574171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist