Provider Demographics
NPI:1619199585
Name:MILLIMAN, RUTH E (OTR)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:E
Last Name:MILLIMAN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:RUTH
Other - Middle Name:E
Other - Last Name:VAN OTTEREN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:282 N SUNTAN DR
Mailing Address - Street 2:
Mailing Address - City:VAIL
Mailing Address - State:AZ
Mailing Address - Zip Code:85641-9444
Mailing Address - Country:US
Mailing Address - Phone:520-762-5270
Mailing Address - Fax:
Practice Address - Street 1:6367 E TANQUE VERDE RD STE 150
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85715-3915
Practice Address - Country:US
Practice Address - Phone:520-296-2900
Practice Address - Fax:520-296-3800
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4566225X00000X
MI5201002834225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ4566OtherSTATE OF AZ BOARD OF OT EXAMINERS
MI5201002834OtherSTATE OF MICHIGAN DEPARTMENT OF COMMUNITY HEALTH BOARD OF OCCUPATIONAL THERAPIST
AZAA607325OtherNBCOT