Provider Demographics
NPI:1205208725
Name:MILLER, KRISTY DENISE (OTR/L)
Entity Type:Individual
Prefix:
First Name:KRISTY
Middle Name:DENISE
Last Name:MILLER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 5TH ST
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:NE
Mailing Address - Zip Code:68405-9508
Mailing Address - Country:US
Mailing Address - Phone:402-499-8612
Mailing Address - Fax:
Practice Address - Street 1:309 EAST 11TH STREET
Practice Address - Street 2:
Practice Address - City:CRETE
Practice Address - State:NE
Practice Address - Zip Code:68333
Practice Address - Country:US
Practice Address - Phone:402-499-8612
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-23
Last Update Date:2015-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1172174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist