Provider Demographics
NPI:1245415702
Name:MILLER, HEATHER DRUSANNA (LMP)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:DRUSANNA
Last Name:MILLER
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:SANNA
Other - Middle Name:
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMP
Mailing Address - Street 1:3417 EVANSTON AVE N
Mailing Address - Street 2:319
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-8626
Mailing Address - Country:US
Mailing Address - Phone:206-892-8618
Mailing Address - Fax:206-357-9371
Practice Address - Street 1:3417 EVANSTON AVE N
Practice Address - Street 2:319
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-8626
Practice Address - Country:US
Practice Address - Phone:206-892-8618
Practice Address - Fax:206-357-9371
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-03
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00024928225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist