Provider Demographics
NPI:1598242653
Name:MCMILLAN, JERAMY (OTD)
Entity Type:Individual
Prefix:
First Name:JERAMY
Middle Name:
Last Name:MCMILLAN
Suffix:
Gender:M
Credentials:OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1031 W SANETTA ST
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83651-5047
Mailing Address - Country:US
Mailing Address - Phone:208-910-2360
Mailing Address - Fax:208-910-2361
Practice Address - Street 1:1031 W SANETTA ST
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83651-5047
Practice Address - Country:US
Practice Address - Phone:208-910-2360
Practice Address - Fax:208-910-2361
Is Sole Proprietor?:No
Enumeration Date:2018-07-22
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics