Provider Demographics
NPI:1538674197
Name:LAWVOR MILLER, TERESA LYNN (LMT, HHP, MMP)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:LYNN
Last Name:LAWVOR MILLER
Suffix:
Gender:F
Credentials:LMT, HHP, MMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508 WEST TOBUK ALLEY
Mailing Address - Street 2:P.O. BOX 1087
Mailing Address - City:NOME
Mailing Address - State:AK
Mailing Address - Zip Code:99762-1087
Mailing Address - Country:US
Mailing Address - Phone:907-443-2633
Mailing Address - Fax:907-387-0455
Practice Address - Street 1:508 WEST TOBUK ALLEY
Practice Address - Street 2:
Practice Address - City:NOME
Practice Address - State:AK
Practice Address - Zip Code:99762-1087
Practice Address - Country:US
Practice Address - Phone:907-443-2633
Practice Address - Fax:907-387-0455
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-05
Last Update Date:2017-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK101223225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist