Provider Demographics
NPI:1710521331
Name:MILLER, CLIFTON A JR (OT)
Entity Type:Individual
Prefix:
First Name:CLIFTON
Middle Name:A
Last Name:MILLER
Suffix:JR
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1835 WIMPOLE ST
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70815-4948
Mailing Address - Country:US
Mailing Address - Phone:225-202-8527
Mailing Address - Fax:
Practice Address - Street 1:309 S VAUGHN DR STE F
Practice Address - Street 2:
Practice Address - City:BRUSLY
Practice Address - State:LA
Practice Address - Zip Code:70719-2593
Practice Address - Country:US
Practice Address - Phone:225-749-2065
Practice Address - Fax:225-749-2427
Is Sole Proprietor?:No
Enumeration Date:2019-11-06
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA303169225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist