Provider Demographics
NPI:1164280376
Name:MILLER, LAURA VINCENT (OTL)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:VINCENT
Last Name:MILLER
Suffix:
Gender:F
Credentials:OTL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50350 HANFORD RD
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-4611
Mailing Address - Country:US
Mailing Address - Phone:734-748-2391
Mailing Address - Fax:
Practice Address - Street 1:50350 HANFORD RD
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-4611
Practice Address - Country:US
Practice Address - Phone:734-748-2391
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-12
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201001361225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist