Provider Demographics
NPI:1598191561
Name:MILLER, RYAN OWEN
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:OWEN
Last Name:MILLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6701 ETON AVE APT 338
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91303-4060
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:233 ORANGEFAIR MALL
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92832-3038
Practice Address - Country:US
Practice Address - Phone:714-870-6116
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-22
Last Update Date:2013-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics