Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | OT12570 | FL |
N | 225XP0200X | Occupational Therapist - Pediatrics | OT12570 | FL |
NPI | 1093913758 |
---|---|
Provider Name | Michele Selon Miles |
First Address | Sanford, FL 32773 |
Second Address | Sanford, FL 32773 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/07/2007 |
Last Update Date | 07/05/2015 |