Provider Demographics
NPI:1164206314
Name:MILLER, DONNA
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:MILLER
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 1:1703 N MCMULLEN BOOTH RD UNIT 1440
Mailing Address - Street 2:
Mailing Address - City:SAFETY HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34695-9653
Mailing Address - Country:US
Mailing Address - Phone:727-485-4660
Mailing Address - Fax:
Practice Address - Street 1:1703 N MCMULLEN BOOTH RD UNIT 1440
Practice Address - Street 2:
Practice Address - City:SAFETY HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34695-9653
Practice Address - Country:US
Practice Address - Phone:727-485-4660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-21
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental TherapistGroup - Single Specialty