Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 10493 | MA |
NPI | 1427319243 |
---|---|
Provider Name | Kimberly L Miller |
First Address | Southwick, MA 01077-9730 |
Second Address | Springfield, MA 01077 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2012 |
Last Update Date | 04/04/2017 |