Provider Demographics
NPI:1528383890
Name:ZIEGLER, MYESA CHEYANNE (LMT)
Entity Type:Individual
Prefix:
First Name:MYESA
Middle Name:CHEYANNE
Last Name:ZIEGLER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:MYESA
Other - Middle Name:CHEYANNE
Other - Last Name:MIKESELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:259 S SEQUOIA PKWY #O-145
Mailing Address - Street 2:
Mailing Address - City:CANBY
Mailing Address - State:OR
Mailing Address - Zip Code:97013
Mailing Address - Country:US
Mailing Address - Phone:503-709-5386
Mailing Address - Fax:888-456-2467
Practice Address - Street 1:17020 SW UPPER BOONES FERRY RD SUITE #300
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97224
Practice Address - Country:US
Practice Address - Phone:503-709-5386
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-30
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR13806225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist