Provider Demographics
NPI:1578837928
Name:MILLER, JEFFERY (COTA/L)
Entity Type:Individual
Prefix:
First Name:JEFFERY
Middle Name:
Last Name:MILLER
Suffix:
Gender:M
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9062 LAKE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:LEWIS CENTER
Mailing Address - State:OH
Mailing Address - Zip Code:43035-8607
Mailing Address - Country:US
Mailing Address - Phone:567-686-5491
Mailing Address - Fax:
Practice Address - Street 1:4301 CLIME RD N
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43228-3403
Practice Address - Country:US
Practice Address - Phone:614-351-9470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-02
Last Update Date:2012-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
04704224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant