Provider Demographics
NPI:1043721004
Name:MILLER, NICOLE TARCELIA
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:TARCELIA
Last Name:MILLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:TARCELIA
Other - Last Name:TOOMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3100 TRAMWAY RD
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27332-7142
Mailing Address - Country:US
Mailing Address - Phone:919-775-5404
Mailing Address - Fax:
Practice Address - Street 1:3100 TRAMWAY RD
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27332-7142
Practice Address - Country:US
Practice Address - Phone:919-775-5404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-18
Last Update Date:2017-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5923224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant