Provider Demographics
NPI:1700543170
Name:MILLER, ERIN MARIE (LMT)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:MARIE
Last Name:MILLER
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 1:5405 3RD ST
Mailing Address - Street 2:
Mailing Address - City:TILLAMOOK
Mailing Address - State:OR
Mailing Address - Zip Code:97141-2905
Mailing Address - Country:US
Mailing Address - Phone:530-318-5058
Mailing Address - Fax:
Practice Address - Street 1:8425 HIGHWAY 101 N
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:OR
Practice Address - Zip Code:97107-9627
Practice Address - Country:US
Practice Address - Phone:503-377-0222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-20
Last Update Date:2021-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR22260225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist