Provider Demographics
NPI:1497534283
Name:MILLER, KAILEY YVONNE (OTD)
Entity Type:Individual
Prefix:DR
First Name:KAILEY
Middle Name:YVONNE
Last Name:MILLER
Suffix:
Gender:F
Credentials:OTD
Other - Prefix:MISS
Other - First Name:KAILEY
Other - Middle Name:YVONNE
Other - Last Name:GRAHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1320 SUNSET DR
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-3741
Mailing Address - Country:US
Mailing Address - Phone:918-264-3773
Mailing Address - Fax:
Practice Address - Street 1:9000 N RODNEY PARHAM RD
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-1646
Practice Address - Country:US
Practice Address - Phone:501-503-5160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-21
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR3838225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist