Provider Demographics
NPI:1205040003
Name:MILLER, ALEXIS L (OTR)
Entity Type:Individual
Prefix:MS
First Name:ALEXIS
Middle Name:L
Last Name:MILLER
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 GLADE PL
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-3164
Mailing Address - Country:US
Mailing Address - Phone:513-325-1747
Mailing Address - Fax:
Practice Address - Street 1:415 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80209-2117
Practice Address - Country:US
Practice Address - Phone:513-325-1747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2009-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8914225X00000X
COOT-1204225X00000X
OHOT.006249225X00000X
IL056007750225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist