Provider Demographics
NPI:1851911036
Name:GILHAM, MICHELLE RENEE (LMT/CNA)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:RENEE
Last Name:GILHAM
Suffix:
Gender:F
Credentials:LMT/CNA
Other - Prefix:MS
Other - First Name:MICHELLE
Other - Middle Name:RENEE
Other - Last Name:SMELTZER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:19605 RIVER RD UNIT 15
Mailing Address - Street 2:
Mailing Address - City:GLADSTONE
Mailing Address - State:OR
Mailing Address - Zip Code:97027
Mailing Address - Country:US
Mailing Address - Phone:503-799-0350
Mailing Address - Fax:
Practice Address - Street 1:16560 S.E. 80TH AVE, PORTLAND OR 97267
Practice Address - Street 2:19650 SE 80TH AVE
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97267
Practice Address - Country:US
Practice Address - Phone:503-799-0350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-17
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORLMT25461225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist