Provider Demographics
NPI:1083974869
Name:MILES, MELINDA
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:
Last Name:MILES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8175 HIGHWAY 281
Mailing Address - Street 2:
Mailing Address - City:GEARY
Mailing Address - State:OK
Mailing Address - Zip Code:73040-4255
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:311 W. MAIN STREET
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OK
Practice Address - Zip Code:73724
Practice Address - Country:US
Practice Address - Phone:580-515-1010
Practice Address - Fax:580-886-2339
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-25
Last Update Date:2012-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator