Provider Demographics
NPI:1477880169
Name:MILLER RYAN, KRISTIN H (OTR/L)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:H
Last Name:MILLER RYAN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:HEIDI
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:101 EXECUTIVE DR
Mailing Address - Street 2:
Mailing Address - City:MOORESTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08057-4236
Mailing Address - Country:US
Mailing Address - Phone:609-707-8613
Mailing Address - Fax:
Practice Address - Street 1:101 EXECUTIVE DR
Practice Address - Street 2:
Practice Address - City:MOORESTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08057-4236
Practice Address - Country:US
Practice Address - Phone:609-707-8613
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-17
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00091000225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist