Provider Demographics
NPI:1518145721
Name:MILLER, KAREN R (OTR/L)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:R
Last Name:MILLER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 STAR MOUNTAIN DR
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:KY
Mailing Address - Zip Code:40336-1136
Mailing Address - Country:US
Mailing Address - Phone:859-893-1406
Mailing Address - Fax:606-723-6029
Practice Address - Street 1:112 STAR MOUNTAIN DR
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:KY
Practice Address - Zip Code:40336-1136
Practice Address - Country:US
Practice Address - Phone:859-893-4106
Practice Address - Fax:606-723-6029
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-11
Last Update Date:2010-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYR2139174400000X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYP400021327OtherMEDICARE INDIV #