Provider Demographics
NPI:1083083315
Name:MILLER, EMILY LYNN (MS, ATC)
Entity Type:Individual
Prefix:MISS
First Name:EMILY
Middle Name:LYNN
Last Name:MILLER
Suffix:
Gender:F
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 OCHRE POINT AVE
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:RI
Mailing Address - Zip Code:02840-4149
Mailing Address - Country:US
Mailing Address - Phone:401-341-2605
Mailing Address - Fax:
Practice Address - Street 1:100 OCHRE POINT AVE
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:RI
Practice Address - Zip Code:02840
Practice Address - Country:US
Practice Address - Phone:401-341-2605
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-16
Last Update Date:2018-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIAT003052255A2300X
CT9062255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer