Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 08016 | MD |
NPI | 1053861351 |
---|---|
Provider Name | Heidi Pamlela Miller |
First Address | Columbia, MD 21046-1506 |
Second Address | Columbia, MD 21046-1506 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2016 |
Last Update Date | 11/10/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
362204 | NBCOT CERTIFICATION (01) |