Provider Demographics
NPI:1467127043
Name:LE, MILEY DIEM
Entity Type:Individual
Prefix:
First Name:MILEY
Middle Name:DIEM
Last Name:LE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1841 N ROCK ROAD CT STE 300
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-4212
Mailing Address - Country:US
Mailing Address - Phone:316-239-1229
Mailing Address - Fax:
Practice Address - Street 1:1841 N ROCK ROAD CT STE 300
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-4212
Practice Address - Country:US
Practice Address - Phone:316-239-1229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-15
Last Update Date:2021-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSK03-15-95762255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer