Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics |
NPI | 1003124355 |
---|---|
Provider Name | Mrs. Vanessa R Miller |
First Address | Charlotte, NC 28214-5420 |
Second Address | Pineville, NC 28134-8563 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2010 |
Last Update Date | 21/09/2010 |