Provider Demographics
NPI:1265261465
Name:MACMILLAN, SOPHIA (LMT)
Entity type:Individual
Prefix:
First Name:SOPHIA
Middle Name:
Last Name:MACMILLAN
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 1:390 LINCOLN ST STE 230
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-6021
Mailing Address - Country:US
Mailing Address - Phone:541-255-2095
Mailing Address - Fax:541-255-2445
Practice Address - Street 1:390 LINCOLN ST STE 230
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-6021
Practice Address - Country:US
Practice Address - Phone:541-255-2095
Practice Address - Fax:541-255-2445
Is Sole Proprietor?:No
Enumeration Date:2024-07-29
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR28401225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist