Provider Demographics
NPI:1407072846
Name:MILLER, LISA HEATHER (OTR)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:HEATHER
Last Name:MILLER
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 SETON DR
Mailing Address - Street 2:
Mailing Address - City:SHREWSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01545-5468
Mailing Address - Country:US
Mailing Address - Phone:508-845-6599
Mailing Address - Fax:
Practice Address - Street 1:799 W BOYLSTON ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01606-3071
Practice Address - Country:US
Practice Address - Phone:508-854-0652
Practice Address - Fax:508-854-0733
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4205225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0701998Medicaid
MA0701998Medicaid