Provider Demographics
NPI:1346027778
Name:MILLER, CONNIE (OTR/L)
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:CONNIE
Other - Middle Name:LEE
Other - Last Name:GILLILAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:4015 GOOD RD
Mailing Address - Street 2:
Mailing Address - City:SEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44273-9732
Mailing Address - Country:US
Mailing Address - Phone:330-612-8552
Mailing Address - Fax:
Practice Address - Street 1:477 E MARKET ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44304-1520
Practice Address - Country:US
Practice Address - Phone:330-375-7357
Practice Address - Fax:330-375-7350
Is Sole Proprietor?:No
Enumeration Date:2023-09-11
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH001798225X00000X
OH001784225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist