Provider Demographics
NPI:1457600900
Name:MILES, KATIE L (LMT)
Entity type:Individual
Prefix:MISS
First Name:KATIE
Middle Name:L
Last Name:MILES
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MISS
Other - First Name:KATIE
Other - Middle Name:L
Other - Last Name:MILES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:821 ELM ST SW
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:OR
Mailing Address - Zip Code:97321
Mailing Address - Country:US
Mailing Address - Phone:541-928-5590
Mailing Address - Fax:541-924-9943
Practice Address - Street 1:821 ELM ST SW
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97321
Practice Address - Country:US
Practice Address - Phone:541-928-5590
Practice Address - Fax:541-924-9943
Is Sole Proprietor?:No
Enumeration Date:2012-08-30
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR18304225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist