Provider Demographics
NPI:1326811092
Name:MILES, RAINA D (COTA)
Entity Type:Individual
Prefix:
First Name:RAINA
Middle Name:D
Last Name:MILES
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:869 MATADOR DR
Mailing Address - Street 2:
Mailing Address - City:TERRYTOWN
Mailing Address - State:LA
Mailing Address - Zip Code:70056-4502
Mailing Address - Country:US
Mailing Address - Phone:504-428-8456
Mailing Address - Fax:
Practice Address - Street 1:4317 EL DORADO ST
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-6601
Practice Address - Country:US
Practice Address - Phone:504-517-5437
Practice Address - Fax:504-533-9272
Is Sole Proprietor?:No
Enumeration Date:2023-11-03
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA338620224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant