Provider Demographics
NPI:1326617309
Name:MILLER, CLEO (MOTR/L)
Entity Type:Individual
Prefix:
First Name:CLEO
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 RODMAN RD APT 1
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:ME
Mailing Address - Zip Code:04210-3942
Mailing Address - Country:US
Mailing Address - Phone:207-376-3022
Mailing Address - Fax:
Practice Address - Street 1:415 RODMAN RD APT 1
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:ME
Practice Address - Zip Code:04210-3942
Practice Address - Country:US
Practice Address - Phone:207-376-3022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-23
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEOT3968Medicaid