Provider Demographics
NPI:1225472889
Name:MILLER, ANGELA MICHELLE (OTR)
Entity Type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:MICHELLE
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 1:97 N COLONIAL DR
Mailing Address - Street 2:
Mailing Address - City:HOPEWELL
Mailing Address - State:VA
Mailing Address - Zip Code:23860-1709
Mailing Address - Country:US
Mailing Address - Phone:804-243-1716
Mailing Address - Fax:
Practice Address - Street 1:235 DUNLOP FARMS BLVD
Practice Address - Street 2:
Practice Address - City:COLONIAL HEIGHTS
Practice Address - State:VA
Practice Address - Zip Code:23834-1792
Practice Address - Country:US
Practice Address - Phone:804-520-1198
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-24
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119005821225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0119005821OtherCOMMONWEALTH OF VIRGINIA BOARD OF MEDICINE