Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225XF0002X | Feeding, Eating & Swallowing | 101451 | MN |
Y | 225XP0200X | Occupational Therapist - Pediatrics | 101451 | MN |
NPI | 1093154536 |
---|---|
Provider Name | Susan Denise Miller |
First Address | Hutchinson, MN 55350-5684 |
Second Address | Hutchinson, MN 55350-5684 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2013 |
Last Update Date | 18/06/2013 |