Individual
MARISSA MILLER SHAYLOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
19365 SW 65TH AVE STE 104, TUALATIN, OR 97062-9196
(503) 486-5199
(503) 486-5190
Mailing address
19365 SW 65TH AVE STE 104, TUALATIN, OR 97062-9196
(503) 486-5199
(503) 486-5190
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
9076006
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
9076006
LICENSE
OR
Enumeration date
07/14/2009
Last updated
08/13/2013
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