Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | ||
Y | 225XP0200X | Occupational Therapist - Pediatrics |
NPI | 1053682716 |
---|---|
Provider Name | Mrs. Allison Duckett Miller |
First Address | Glendale, AZ 85308-8067 |
Second Address | Glendale, AZ 85308-8067 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/01/2012 |
Last Update Date | 25/01/2012 |