The shallow, magnitude 6.4 quake late Tuesday night caused at least four buildings in worst-hit Hualien county to cave in and tilt dangerously, killing four people.
Video footage and photos showed several midsized buildings leaning at sharp angles, their lowest floors crushed into mangled heaps of concrete, shattered glass, bent iron beams and other debris.
Firefighters could be seen climbing ladders hoisted against windows as they sought to reach residents inside apartments.
Taiwanese President Tsai Ing-wen moved to reassure the Taiwanese public that every effort would be made to look for survivors.
In a post on her official Facebook page, Tsai said she arrived in Hualien Wednesday to review rescue efforts.
Tsai said she "ordered search and rescue workers not to give up on any opportunity to save people, while keeping their own safety in mind."
The official news agency said all but two of the 145 people who could not be reached might be in the Yunmen Cuiti building, a 12-story apartment building, though it said it did not immediately have an estimate of how many were trapped.
Chen Tzai-Tung, a worker with the government disaster center, said it was not safe for rescuers to enter the Yunmen building because it was still leaning farther bit by bit.
The headcount of missing people is based on registered occupants, Chen said by phone, adding that firefighters were evaluating whether to prop up the building with steel.
A hotel employee died when the ground floor caved in at the Marshal Hotel, and another person died in a residential building, the agency reported.
A maintenance worker who was rescued after being trapped in the hotel's basement said the force of the earthquake was unusual.
"At first it wasn't that big ... we get this sort of thing all the time and it's really nothing. But then it got really terrifying," Chen Ming-hui said after he was reunited with his son and grandson. "It was really scary."
Taiwanese media reported that a separate hotel known as the Beautiful Life Hotel also was tilting. Taiwan's Central News Agency posted photos showing a road fractured in several parts.
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