Provider Demographics
NPI:1629381298
Name:MILLER, LEAH MARIE (BS, RD, LD)
Entity Type:Individual
Prefix:MS
First Name:LEAH
Middle Name:MARIE
Last Name:MILLER
Suffix:
Gender:F
Credentials:BS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27100 CEDAR RD
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-1109
Mailing Address - Country:US
Mailing Address - Phone:216-839-6651
Mailing Address - Fax:
Practice Address - Street 1:27100 CEDAR RD
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-1109
Practice Address - Country:US
Practice Address - Phone:216-839-6651
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-23
Last Update Date:2010-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6098133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4366958Medicaid
OH0318000001Medicare NSC
OH365094Medicare Oscar/Certification