Individual
AMANDA ANNE MILES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6637 SE MILWAUKIE AVE, PORTLAND, OR 97202-5658
(503) 410-0675
Mailing address
13335 SW UTE ST, TUALATIN, OR 97062-7329
(503) 410-0675
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
23114
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
23114
ALL OTHER NON MEDICARE
OR
Enumeration date
08/16/2019
Last updated
08/16/2019
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