Provider Demographics
NPI:1639391584
Name:MILLER, JASON R (ATC)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:R
Last Name:MILLER
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 WINDSOR CIRCLE
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74074
Mailing Address - Country:US
Mailing Address - Phone:405-269-9575
Mailing Address - Fax:
Practice Address - Street 1:OKLAHOMA STATE UNIVERSITY
Practice Address - Street 2:ATHLETICS CENTER
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74078
Practice Address - Country:US
Practice Address - Phone:405-744-6741
Practice Address - Fax:405-744-0358
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4832255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer