Basic Information
| Provider Information | |||||||||
| NPI: | 1528383890 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ZIEGLER | ||||||||
| FirstName: | MYESA | ||||||||
| MiddleName: | CHEYANNE | ||||||||
| NamePrefix: | |||||||||
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| Credential: | LMT | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | MIKESELL | ||||||||
| OtherFirstName: | MYESA | ||||||||
| OtherMiddleName: | CHEYANNE | ||||||||
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| OtherCredential: | LMT | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 259 S SEQUOIA PKWY #O-145 | ||||||||
| Address2: | |||||||||
| City: | CANBY | ||||||||
| State: | OR | ||||||||
| PostalCode: | 97013 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5037095386 | ||||||||
| FaxNumber: | 8884562467 | ||||||||
| Practice Location | |||||||||
| Address1: | 17020 SW UPPER BOONES FERRY RD SUITE #300 | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 97224 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5037095386 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/30/2010 | ||||||||
| LastUpdateDate: | 10/22/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225700000X | 13806 | OR | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Massage Therapist |
No ID Information.