Provider Demographics
NPI:1467671149
Name:MILLER, KIMBERLY SUE (OTRL OCCUPATIONAL TH)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:SUE
Last Name:MILLER
Suffix:
Gender:F
Credentials:OTRL OCCUPATIONAL TH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 182
Mailing Address - Street 2:22 MAPLE STREET
Mailing Address - City:RIXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:16745-0182
Mailing Address - Country:US
Mailing Address - Phone:814-465-9562
Mailing Address - Fax:
Practice Address - Street 1:723 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BRADFORD
Practice Address - State:PA
Practice Address - Zip Code:16701-3242
Practice Address - Country:US
Practice Address - Phone:814-362-4621
Practice Address - Fax:814-362-1066
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2015-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC009742225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1013965240001Medicaid