Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 0119-007629 | VA |
N | 225XG0600X | Occupational Therapist - Gerontology | 11609 | NC |
N | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 0119-007629 | VA |
N | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 11609 | NC |
NPI | 1790242196 |
---|---|
Provider Name | Renae Miller |
First Address | Virginia Beach, VA 23462-7702 |
Second Address | Virginia Beach, VA 23452-1711 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2019 |
Last Update Date | 22/02/2019 |