Provider Demographics
NPI:1063636959
Name:MILLER, ROBB PATRICK (OT)
Entity Type:Individual
Prefix:MR
First Name:ROBB
Middle Name:PATRICK
Last Name:MILLER
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2115 DECATUR AVE N
Mailing Address - Street 2:
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55427-3246
Mailing Address - Country:US
Mailing Address - Phone:763-545-9952
Mailing Address - Fax:612-262-6299
Practice Address - Street 1:800 E 28TH ST
Practice Address - Street 2:MAIL ROUTE 12213
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55407-3723
Practice Address - Country:US
Practice Address - Phone:612-863-6187
Practice Address - Fax:612-863-6299
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN102358225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist