Provider Demographics
NPI:1336308295
Name:MILLER, LAURIE K (MOT,OTR)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:K
Last Name:MILLER
Suffix:
Gender:F
Credentials:MOT,OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:855 DAVIS BLVD
Mailing Address - Street 2:SUITE 600
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-8244
Mailing Address - Country:US
Mailing Address - Phone:817-310-5457
Mailing Address - Fax:817-310-3428
Practice Address - Street 1:855 DAVIS BLVD
Practice Address - Street 2:SUITE 600
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-8244
Practice Address - Country:US
Practice Address - Phone:817-310-5457
Practice Address - Fax:817-310-3428
Is Sole Proprietor?:No
Enumeration Date:2008-06-05
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX103526225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist