Provider Demographics
NPI:1356326771
Name:MILLER, THOMAS W
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:W
Last Name:MILLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1605 ST RT 60
Mailing Address - Street 2:STE 3
Mailing Address - City:VERMILION
Mailing Address - State:OH
Mailing Address - Zip Code:44089
Mailing Address - Country:US
Mailing Address - Phone:440-967-2508
Mailing Address - Fax:440-967-4023
Practice Address - Street 1:1605 ST RT 60
Practice Address - Street 2:STE 3
Practice Address - City:VERMILION
Practice Address - State:OH
Practice Address - Zip Code:44089
Practice Address - Country:US
Practice Address - Phone:440-967-2508
Practice Address - Fax:440-967-4023
Is Sole Proprietor?:No
Enumeration Date:2005-12-08
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP1905235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000325529OtherANTHEM BLUE CROSS