Provider Demographics
NPI:1629726682
Name:RICHARDSON MILLER, CAROLINE SHAW (LPMT, MT-BC)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:SHAW
Last Name:RICHARDSON MILLER
Suffix:
Gender:F
Credentials:LPMT, MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 MORNING DOVE LN
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-6076
Mailing Address - Country:US
Mailing Address - Phone:678-779-3836
Mailing Address - Fax:
Practice Address - Street 1:320 MORNING DOVE LN
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-6076
Practice Address - Country:US
Practice Address - Phone:678-779-3836
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-17
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMUT000241225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist