Provider Demographics
NPI:1578252201
Name:MILLER, THERESA MICHELLE
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:MICHELLE
Last Name:MILLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1131 E BROAD ST
Mailing Address - Street 2:
Mailing Address - City:ELYRIA
Mailing Address - State:OH
Mailing Address - Zip Code:44035-6305
Mailing Address - Country:US
Mailing Address - Phone:216-270-7464
Mailing Address - Fax:440-387-4706
Practice Address - Street 1:1131 E BROAD ST
Practice Address - Street 2:
Practice Address - City:ELYRIA
Practice Address - State:OH
Practice Address - Zip Code:44035-6305
Practice Address - Country:US
Practice Address - Phone:216-270-7464
Practice Address - Fax:440-387-4706
Is Sole Proprietor?:No
Enumeration Date:2023-05-08
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator