Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 1919A | SC |
NPI | 1023305943 |
---|---|
Provider Name | Kristi Miller |
First Address | Abbeville, SC 29620-5259 |
Second Address | Laurens, SC 29360-2672 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2011 |
Last Update Date | 29/06/2011 |