Provider Demographics
NPI:1346501491
Name:MILLER, GRETCHEN (ATC, CSCS)
Entity Type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1019 PAWAA LN
Mailing Address - Street 2:# 8
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96826-2143
Mailing Address - Country:US
Mailing Address - Phone:808-383-9814
Mailing Address - Fax:
Practice Address - Street 1:45-386 KANEOHE BAY DR
Practice Address - Street 2:
Practice Address - City:KANEOHE
Practice Address - State:HI
Practice Address - Zip Code:96744-2248
Practice Address - Country:US
Practice Address - Phone:808-347-3444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-05
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer