Provider Demographics
NPI:1639379399
Name:MIAKINKOFF, ELIZABETH A (LMT, LMP, CA)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:A
Last Name:MIAKINKOFF
Suffix:
Gender:F
Credentials:LMT, LMP, CA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16753 NE HALSEY ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97230-5666
Mailing Address - Country:US
Mailing Address - Phone:503-804-9711
Mailing Address - Fax:
Practice Address - Street 1:16753 NE HALSEY ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97230-5666
Practice Address - Country:US
Practice Address - Phone:503-804-9711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-20
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR12878225700000X
WAMA00022144225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist