Provider Demographics
NPI:1750653481
Name:COATES, MICHELLE L (LMT)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:L
Last Name:COATES
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1161 NW PARK VIEW ST APT 1
Mailing Address - Street 2:
Mailing Address - City:SEAL ROCK
Mailing Address - State:OR
Mailing Address - Zip Code:97376-9790
Mailing Address - Country:US
Mailing Address - Phone:541-961-4897
Mailing Address - Fax:
Practice Address - Street 1:1161 NW PARK VIEW ST APT 1
Practice Address - Street 2:
Practice Address - City:SEAL ROCK
Practice Address - State:OR
Practice Address - Zip Code:97376-9790
Practice Address - Country:US
Practice Address - Phone:541-961-4897
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-26
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR17246225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist