Provider Demographics
NPI:1376995217
Name:MILLER, DOROTHY (LMT, CR)
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:LMT, CR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:376 SW BLUFF DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-1399
Mailing Address - Country:US
Mailing Address - Phone:541-350-8160
Mailing Address - Fax:
Practice Address - Street 1:376 SW BLUFF DR
Practice Address - Street 2:SUITE 1
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-1399
Practice Address - Country:US
Practice Address - Phone:541-350-8160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-03
Last Update Date:2016-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR20604225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist