Provider Demographics
NPI:1639408966
Name:MILLER, STEPHANIE CHRISTINE (COTA)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:CHRISTINE
Last Name:MILLER
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:299 BALLOU RD
Mailing Address - Street 2:
Mailing Address - City:PORTER CORNERS
Mailing Address - State:NY
Mailing Address - Zip Code:12859-1806
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:905 TOWER RD
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:PA
Practice Address - Zip Code:19007-3116
Practice Address - Country:US
Practice Address - Phone:215-285-2239
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-16
Last Update Date:2009-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005526-1224Z00000X
PAOP006797224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant