Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | 31005770A | IN |
Y | 225XP0200X | Occupational Therapist - Pediatrics | 134115 | KY |
NPI | 1003212804 |
---|---|
Provider Name | Gina Miller |
First Address | Louisville, KY 40223-1607 |
Second Address | Crestwood, KY 40014-9040 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/11/2014 |
Last Update Date | 15/05/2020 |