Provider Demographics
NPI:1427184340
Name:MILLER, MELANIE DOREEN (MA)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:DOREEN
Last Name:MILLER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1123 172ND ST
Mailing Address - Street 2:
Mailing Address - City:HAZEL CREST
Mailing Address - State:IL
Mailing Address - Zip Code:60429-1910
Mailing Address - Country:US
Mailing Address - Phone:708-798-9114
Mailing Address - Fax:773-363-3481
Practice Address - Street 1:1123 172ND ST
Practice Address - Street 2:
Practice Address - City:HAZEL CREST
Practice Address - State:IL
Practice Address - Zip Code:60429-1910
Practice Address - Country:US
Practice Address - Phone:708-798-9114
Practice Address - Fax:773-363-3481
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner