Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter | 02029087 | AZ |
NPI | 1083834154 |
---|---|
Provider Name | Mrs. Dolores May Miller |
First Address | Sierra Vista, AZ 85635-3550 |
Second Address | Sierra Vista, AZ 85635-3550 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/04/2007 |
Last Update Date | 09/07/2007 |