Provider Demographics
NPI:1235267485
Name:CARLSONMILLER, JOAN V
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:
Last Name:CARLSONMILLER
Suffix:V
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:633 TOLLIS PKWY
Mailing Address - Street 2:
Mailing Address - City:BROADVIEW HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44147-1811
Mailing Address - Country:US
Mailing Address - Phone:440-582-3563
Mailing Address - Fax:
Practice Address - Street 1:633 TOLLIS PKWY
Practice Address - Street 2:
Practice Address - City:BROADVIEW HTS
Practice Address - State:OH
Practice Address - Zip Code:44147-1811
Practice Address - Country:US
Practice Address - Phone:440-582-3563
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH000016225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist