Provider Demographics
NPI:1518515790
Name:MILLER, FOREST DANIEL (OTR/L)
Entity Type:Individual
Prefix:
First Name:FOREST
Middle Name:DANIEL
Last Name:MILLER
Suffix:
Gender:M
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 1:40 STONECROP LN
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:17345-1346
Mailing Address - Country:US
Mailing Address - Phone:717-676-3017
Mailing Address - Fax:
Practice Address - Street 1:50 N MALIN RD
Practice Address - Street 2:
Practice Address - City:BROOMALL
Practice Address - State:PA
Practice Address - Zip Code:19008-1429
Practice Address - Country:US
Practice Address - Phone:610-356-0800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-30
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC015844225X00000X
MA225X00000X
NH3349225X00000X
MA14627225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist