Provider Demographics
NPI:1225123359
Name:MILLS, TERRY MCDONALD (OTR L)
Entity Type:Individual
Prefix:MR
First Name:TERRY
Middle Name:MCDONALD
Last Name:MILLS
Suffix:
Gender:M
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 1:2530 NW 63RD AVENUE
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33313
Mailing Address - Country:US
Mailing Address - Phone:754-234-4779
Mailing Address - Fax:954-749-8331
Practice Address - Street 1:2530 NW 63RD AVE
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33313-2205
Practice Address - Country:US
Practice Address - Phone:754-234-4779
Practice Address - Fax:954-749-8331
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT 9303225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist