Provider Demographics
NPI:1598850729
Name:MILLER, THERESA KIERNAN (OTR/CHT)
Entity Type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:KIERNAN
Last Name:MILLER
Suffix:
Gender:F
Credentials:OTR/CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3787 SHIPYARD BLVD
Mailing Address - Street 2:PHYSICAL THERAPY
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-6148
Mailing Address - Country:US
Mailing Address - Phone:910-341-2444
Mailing Address - Fax:910-332-1519
Practice Address - Street 1:3787 SHIPYARD BLVD
Practice Address - Street 2:PHYSICAL THERAPY
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-6148
Practice Address - Country:US
Practice Address - Phone:910-341-2444
Practice Address - Fax:910-332-1519
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6815225XH1200X
FL3109225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6815OtherOCCUPATIONAL THERAPY LICENSE
FL3109OtherOCCUPATIONAL THERAPY LICE