Provider Demographics
NPI:1518632470
Name:MILLER, JENNIFER LOYCE (OT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LOYCE
Last Name:MILLER
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4032 WALES RD
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:LA
Mailing Address - Zip Code:70441-3793
Mailing Address - Country:US
Mailing Address - Phone:985-517-0777
Mailing Address - Fax:
Practice Address - Street 1:17010 OLD COVINGTON HWY
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-5232
Practice Address - Country:US
Practice Address - Phone:985-345-8787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-12
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAOTT.Z12368225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty