Provider Demographics
NPI:1609838879
Name:MINER, MICHAEL A (OTR L)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:A
Last Name:MINER
Suffix:
Gender:M
Credentials:OTR L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:978 MOUNTAIN CITY HWY
Mailing Address - Street 2:
Mailing Address - City:ELKO
Mailing Address - State:NV
Mailing Address - Zip Code:89801-2881
Mailing Address - Country:US
Mailing Address - Phone:775-738-4666
Mailing Address - Fax:775-738-4776
Practice Address - Street 1:978 MOUNTAIN CITY HWY
Practice Address - Street 2:
Practice Address - City:ELKO
Practice Address - State:NV
Practice Address - Zip Code:89801-2881
Practice Address - Country:US
Practice Address - Phone:775-738-4666
Practice Address - Fax:775-738-4776
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2015-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV0693225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100576Medicare ID - Type Unspecified
NV100502072Medicaid