Provider Demographics
NPI:1780901959
Name:MIRANDA, ALICIA M (LMT, COTA (RET))
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:M
Last Name:MIRANDA
Suffix:
Gender:
Credentials:LMT, COTA (RET)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20070 LARKSPUR LN APT 66
Mailing Address - Street 2:
Mailing Address - City:WEST LINN
Mailing Address - State:OR
Mailing Address - Zip Code:97068-2381
Mailing Address - Country:US
Mailing Address - Phone:727-686-6848
Mailing Address - Fax:
Practice Address - Street 1:4949 MEADOWS RD STE 140
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-3156
Practice Address - Country:US
Practice Address - Phone:503-305-7244
Practice Address - Fax:503-305-8849
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-28
Last Update Date:2025-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA 14848224Z00000X
FLMA41682225700000X
OR24185225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant