Provider Demographics
NPI:1063488393
Name:MILLER, ANGELIQUE CATHERINE (MS,OTR/L)
Entity Type:Individual
Prefix:
First Name:ANGELIQUE
Middle Name:CATHERINE
Last Name:MILLER
Suffix:
Gender:F
Credentials:MS,OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 N 7TH ST
Mailing Address - Street 2:
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17201-1720
Mailing Address - Country:US
Mailing Address - Phone:717-262-4650
Mailing Address - Fax:717-262-4658
Practice Address - Street 1:112 N 7TH ST
Practice Address - Street 2:
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17201-1720
Practice Address - Country:US
Practice Address - Phone:717-262-4650
Practice Address - Fax:717-262-4658
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6533225X00000X
PAOC010325225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist